Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Bloom Primary Mo II, LLC

Organization Internal Medicine Physician · NPI 1417871013

Bloom Primary Mo II, LLC is an Internal Medicine Physician in Saint Louis, Missouri. Registered with an NPI since 2026.

In the registry since
2026
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

540 Maryville Centre Dr Ste 340
Saint Louis, MO 63141-5831
Phone: (303) 993-1330
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X

Record details

NPI number1417871013
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Debra Moon Wadelton — Authorized Official · (720) 923-1250
NPI enumeratedAugust 6, 2026
Last updated in NPPESAugust 6, 2026
Certification dateAugust 6, 2026
Mailing address12600 W Colfax Ave Ste 200, Lakewood, CO 80215-3733

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