MEDICARE: MIA OF ST CHARLES COUNTY LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1922093632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIA OF ST CHARLES COUNTY LLC

Provider Business Mailing Address
First Line	:	PO BOX 868
Second Line	:
City	:	EDWARDSVILLE
State	:	IL
Zip	:	62025-0868
Country	:	US
Telephone Number	:	618-659-1167
Fax Number	:	618-659-1197

Provider Business Practice Location Address
First Line	:	1475 KISKER RD
Second Line	:	STE 145
City	:	SAINT CHARLES
State	:	MO
Zip	:	63304-8781
Country	:	US
Telephone Number	:	636-922-5151
Fax Number	:	636-922-5454

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. STEVEN MICHAEL MCRAE
Credential	:
Telephone Number	:	618-659-1167

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	08/22/2020

Similar Medicare Providers

1841251048 — DR. THOMAS A TYREE M.D.
Practice Location Address:

1475 KISKER RD , SUITE 200
SAINT CHARLES, MO
63304-8781

Practice Phone: 636-498-5850
Practice Fax: 636-669-2401

1134180607 — DR. RICHARD F VAUGHN M.D.
Practice Location Address:

1475 KISKER RD
SAINT CHARLES, MO
63304-8781

Practice Phone: 636-498-5850
Practice Fax: 636-669-2401

1952362444 — DR. ALAN W HOLSHOUSER M.D.
Practice Location Address:

1475 KISKER RD , SUITE 200
SAINT CHARLES, MO
63304-8781

Practice Phone: 636-498-5830
Practice Fax: 636-498-5846

1609838135 — DR. JASON M MITCHELL M.D.
Practice Location Address:

1475 KISKER RD
SAINT CHARLES, MO
63304-8781

Practice Phone: 636-498-5810
Practice Fax: 636-669-2401

1740242288 — DR. THOMAS A LORD M.D.
Practice Location Address:

1475 KISKER RD , SUITE 200
SAINT CHARLES, MO
63304-8781

Practice Phone: 636-498-5810
Practice Fax: 636-498-5826

1770545212 — DR. SUE SATEESHA M.D.
Practice Location Address:

1475 KISKER RD , SUITE 200
SAINT CHARLES, MO
63304-8781

Practice Phone: 636-498-5830
Practice Fax: 636-498-5846

Directions to “MIA OF ST CHARLES COUNTY 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 © 2007-2025 (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.