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NPI Code Detail

MEDICARE: PRIMEBRIDGE PSYCHIATRIC CARE LLC

MEDICARE: PRIMEBRIDGE PSYCHIATRIC CARE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1306790092
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRIMEBRIDGE PSYCHIATRIC CARE LLC
Provider Business Mailing Address
First Line : 459 DUSTY BROOK DR
Second Line :
City : O FALLON
State : MO
Zip : 63366-5088
Country : US
Telephone Number : 346-213-3023
Fax Number : 314-783-2085
Provider Business Practice Location Address
First Line : 536 N TAYLOR AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63108-1888
Country : US
Telephone Number : 314-266-8139
Fax Number : 314-783-2085
Authorized Official
Title or Position : MANAGING MEMBER
Name : CHILEME U OCHULOR
Credential : DNP, PMHNP-BC
Telephone Number : 346-213-3023
Provider Enumeration Date : 02/21/2026
Last Update Date : 05/28/2026

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