1255354643 NPI number — BDM ASSOCIATES LLC

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 1255354643 NPI number — BDM ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BDM ASSOCIATES LLC
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:
PEAK PERFORMANCE PHYSICAL THERAPY & SPORTS MEDICINE
Provider Other Organization Name Type Code:
3
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:
1255354643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3301 BERRYWOOD DR
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65201-6517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-449-8771
Provider Business Mailing Address Fax Number:
573-449-6563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E DAVIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65248-1405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-248-3053
Provider Business Practice Location Address Fax Number:
660-248-2682
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REEDER
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DIRECTOR OF BILLING
Authorized Official Telephone Number:
573-449-6082

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 834765000 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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