1174699193 NPI number — ENDOCRINOLOGY DIABETES & METABOLISM CONSULTANTS P C

Table of content: (NPI 1174699193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174699193 NPI number — ENDOCRINOLOGY DIABETES & METABOLISM CONSULTANTS P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENDOCRINOLOGY DIABETES & METABOLISM CONSULTANTS P C
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider's Other Name Information

Provider Other Organization Name:
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NPI Number Information

NPI Number:
1174699193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10004 KENNERLY RD
Provider Second Line Business Mailing Address:
SUITE 160B
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63128-2141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-842-1588
Provider Business Mailing Address Fax Number:
314-543-5298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10004 KENNERLY RD
Provider Second Line Business Practice Location Address:
SUITE 160B
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63128-2141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-842-1588
Provider Business Practice Location Address Fax Number:
314-543-5298
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THAMPY
Authorized Official First Name:
K
Authorized Official Middle Name:
GEORGE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
314-842-1588

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  112762 , 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)





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