1164580742 NPI number — JOHN F HAGY PH.D.

Table of content: JOHN F HAGY PH.D. (NPI 1164580742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164580742 NPI number — JOHN F HAGY PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAGY
Provider First Name:
JOHN
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164580742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
815 S ASH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEVADA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64772-3222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-667-8352
Provider Business Mailing Address Fax Number:
417-667-9216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 S ASH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEVADA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64772-3222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-667-8352
Provider Business Practice Location Address Fax Number:
417-667-9216
Provider Enumeration Date:
12/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  002653 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 25752014 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".