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NPI Code Detail

MEDICARE: SAMUEL POND PA-C

MEDICARE: SAMUEL POND PA-C
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
12255A2300XAthletic Trainer
2363A00000XPhysician Assistant2025042977MO

General Provider Information

NPI Number : 1083124432
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL POND PA-C
Provider Business Mailing Address
First Line : 701 S NEW BALLAS RD STE 510
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63141-8726
Country : US
Telephone Number : 314-251-6710
Fax Number :
Provider Business Practice Location Address
First Line : 701 S NEW BALLAS RD STE 510
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63141-8726
Country : US
Telephone Number : 314-251-6710
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2017
Last Update Date : 10/15/2025

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Directions to “ SAMUEL POND PA-C” Practice Location

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