MEDICARE: MEDITELECARE OF MISSOURI LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	104100000X	Social Worker
2	2084P0800X	Psychiatry Physician
3	2084P0805X	Geriatric Psychiatry Physician
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
5	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1013416585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDITELECARE OF MISSOURI LLC

Provider Business Mailing Address
First Line	:	PO BOX 1595
Second Line	:
City	:	MIDDLETOWN
State	:	CT
Zip	:	06457-8095
Country	:	US
Telephone Number	:	860-788-6404
Fax Number	:	860-829-0495

Provider Business Practice Location Address
First Line	:	5661 TELEGRAPH RD STE 4B
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-4275
Country	:	US
Telephone Number	:	860-788-6404
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING & ENROLLMENT MANAGER
Name	:	ANDREA GODFREY
Credential	:
Telephone Number	:	860-398-6441

Provider Enumeration Date	:	02/09/2018
Last Update Date	:	05/05/2025

Similar Medicare Providers

1952252793 — SOUTH COUNTY SPORT & SPINE, LLC
Practice Location Address:

5661 TELEGRAPH RD STE 5B
SAINT LOUIS, MO
63129-4275

Practice Phone: 314-949-6459
Practice Fax:

1154012516 — SAHIN DZANANOVIC DC
Practice Location Address:

5661 TELEGRAPH RD STE 5B
SAINT LOUIS, MO
63129-4275

Practice Phone: 314-949-6459
Practice Fax:

1932208048 — DR. ROBERT V RIVLIN D.M.D.
Practice Location Address:

5661 TELEGRAPH RD
SAINT LOUIS, MO
63129-4275

Practice Phone: 314-846-0606
Practice Fax:

1003088998 — CRAIG RESOURCES LLC
Practice Location Address:

5661 TELEGRAPH RD STE 5B
SAINT LOUIS, MO
63129-4275

Practice Phone: 314-843-0316
Practice Fax: 314-843-0317

1164809869 — CRAIG RESOURCES, INC.
Practice Location Address:

5661 TELEGRAPH RD STE 5B
SAINT LOUIS, MO
63129-4275

Practice Phone: 314-843-0316
Practice Fax: 316-843-0317

1073402442 — SUSTAINABLE PELVIC HEALTH LLC
Practice Location Address:

5661 TELEGRAPH RD STE 4B
SAINT LOUIS, MO
63129-4275

Practice Phone: 913-214-9956
Practice Fax:

Directions to “MEDITELECARE OF MISSOURI LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.