1225079791 NPI number — M ROBERT HILL MD

Table of content: (NPI 1225079791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225079791 NPI number — M ROBERT HILL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M ROBERT HILL MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1225079791
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6125 CLAYTON AVE
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63139-3265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-768-3220
Provider Business Mailing Address Fax Number:
314-768-5607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6125 CLAYTON AVE
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63139-3265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-768-3220
Provider Business Practice Location Address Fax Number:
314-768-5607
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HILL
Authorized Official First Name:
M
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
314-768-3220

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00005690032 . This is a "AETNA PRIV PRACTICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110003130 . This is a "RR MCR PRIV PRACTICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 181103 . This is a "BCBS PRIV PRACTICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201050606 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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