MEDICARE: MRS. HILARY A FRESCOLN MD

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
1	207Q00000X	Family Medicine Physician	2011017815	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01106286	OTHER	MO	RR MCR
2	431560263	OTHER	MO	TRICARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366478588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HILARY A FRESCOLN MD

Provider Business Mailing Address
First Line	:	PO BOX 505164
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63150-5164
Country	:	US
Telephone Number	:	417-829-4620
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 EAST HWY 60
Second Line	:
City	:	MT VIEW
State	:	MO
Zip	:	65548-0000
Country	:	US
Telephone Number	:	417-934-2251
Fax Number	:	417-934-2871

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	10/02/2014

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