MEDICARE: DR. JOHN ALAN VELLINGA D.O.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	R5P16	MO
2	208VP0000X	Pain Medicine Physician	R5P16	MO

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	050055140	OTHER	MO	MEDICARE RAILROAD

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	197791	OTHER	MO	BCBS
2	2000224	OTHER	MO	PHP
3	249776	OTHER	MO	HEALTHLINK
4	072246	OTHER	MO	FMH/EXCLUSIVE CHOICE
5	197791	OTHER	MO	BLUE CHOICE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	35554	OTHER	MO	GHP
8	35554	OTHER	MO	CMR
10	A003431711815	OTHER	MO	TRICARE
11	F04439	OTHER	MO	MERCY
12	431711815	OTHER	MO	NALC
13	491711815	OTHER	MO	1ST HEALTH
14	63868010001	OTHER	MO	CIGNA
15	2000224	OTHER	MO	UHC
16	431711815	OTHER	MO	GREATWEST
17	5339096	OTHER	MO	AETNA

NPI Number	:	1679514145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ALAN VELLINGA D.O.

Provider Business Mailing Address
First Line	:	4800 MEXICO RD
Second Line	:	SUITE 101
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-1666
Country	:	US
Telephone Number	:	636-936-0400
Fax Number	:	636-936-2252

Provider Business Practice Location Address
First Line	:	4800 MEXICO RD
Second Line	:	SUITE 101
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-1666
Country	:	US
Telephone Number	:	636-936-0400
Fax Number	:	636-936-2252

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	05/09/2012

4800 MEXICO RD , SUITE 104
SAINT PETERS, MO
63376-1666

Practice Phone: 636-939-9540
Practice Fax: 636-939-9886