Healthcare Provider Details

I. General information

NPI: 1891689790
Provider Name (Legal Business Name): INTEGRATED SENIOR CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12395 OLIVE BLVD STE 200
SAINT LOUIS MO
63141-5465
US

IV. Provider business mailing address

1449 S MICHIGAN AVE STE 13138
CHICAGO IL
60605-2810
US

V. Phone/Fax

Practice location:
  • Phone: 636-233-7249
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH MITCHELL
Title or Position: OWNER
Credential: MD
Phone: 270-993-4789