1245237858 NPI number — DR. NORMAN C NEEB DO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245237858 NPI number — DR. NORMAN C NEEB DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEEB
Provider First Name:
NORMAN
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1245237858
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1073
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARYLAND HEIGHTS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63043-0073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-984-0033
Provider Business Mailing Address Fax Number:
314-991-8960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12166 OLD BIG BEND RD
Provider Second Line Business Practice Location Address:
STE. 108
Provider Business Practice Location Address City Name:
KIRKWOOD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63122-6844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-984-0033
Provider Business Practice Location Address Fax Number:
314-984-0020
Provider Enumeration Date:
06/29/2005

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: 208D00000X , with the licence number:  R1J92 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204D00000X , with the licence number: R1J92 , 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: 180821 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4585451 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 133154 . This is a "HEALTHLINK PROVIDER NUMBE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 242604312 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 431554207 . This is a "MERCY HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2300025 . This is a "UNITED HEALTH CARE PROV #" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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