MEDICARE: MOUND CITY CARDIOVASCULAR CONSULTANTS, INC.

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	207R00000X	Internal Medicine Physician	R3F19	MO
2	207RC0000X	Cardiovascular Disease Physician	R3F19	MO
3	207RC0000X	Cardiovascular Disease Physician		IL
4	207R00000X	Internal Medicine Physician		IL

General Provider Information

NPI Number	:	1437277589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUND CITY CARDIOVASCULAR CONSULTANTS, INC.

Provider Business Mailing Address
First Line	:	11939 MANCHESTER RD
Second Line	:	#408
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-4502
Country	:	US
Telephone Number	:	314-381-4141
Fax Number	:	314-381-4143

Provider Business Practice Location Address
First Line	:	3409 UNION BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-1127
Country	:	US
Telephone Number	:	314-381-4141
Fax Number	:	314-381-4143

Authorized Official
Title or Position	:	OWNER-PRESIDENT
Name	:	DR. WENDELL NELSON WILLIAMS
Credential	:	M.D.
Telephone Number	:	314-381-4141

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	09/11/2025

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