1205839354 NPI number — DR. EMIL A DIFILIPPO M.D.

Table of content: DR. EMIL A DIFILIPPO M.D. (NPI 1205839354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205839354 NPI number — DR. EMIL A DIFILIPPO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIFILIPPO
Provider First Name:
EMIL
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.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:
1205839354
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12639 OLD TESSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63128-2786
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-849-0311
Provider Business Mailing Address Fax Number:
314-849-4423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9323 PHOENIX VILLAGE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
O FALLON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63366-4281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-561-5030
Provider Business Practice Location Address Fax Number:
636-561-5033
Provider Enumeration Date:
05/23/2005

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: 207X00000X , with the licence number:  30530 , 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: 21646 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: SP10135 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 45619 . This is a "CMR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4432V6097 . This is a "HEALTHCARE USA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 119066 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6034V3458 . This is a "GHP/ADVANTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 900093 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9042 . This is a "EXCLUSIVE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4061313 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".