Organization
WELLCARE MEDICARE
Active
Other names
Merit Health Wesley, Wellcare
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB CORNELIUS PARKER MD, DO (CUSTOMER SUPPORT)
(601) 268-8000
Entity
Organization
Contact information
Practice address
7700 FORSYTH BLVD, SAINT LOUIS, MO 63105-1807
(314) 725-4477
Mailing address
7700 FORSYTH BLVD, SAINT LOUIS, MO 63105-1807
(314) 725-4477
Taxonomy
Speciality
Code
Description
License number
State
163WP0000X
Pain Management Registered Nurse
—
—
291U00000X
Clinical Medical Laboratory
—
—
305R00000X
Preferred Provider Organization
Primary
—
—
3140N1450X
Pediatric Skilled Nursing Facility
—
—
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12365433061
CORPORATE OFFICE
MO
01
—
8420042213
ENVISION HEALTHCARE
MS
Enumeration date
01/14/2021
Last updated
11/11/2025
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