1407852213 NPI number — SUSIE EARLY MD PC

Table of content: BENJAMIN RUSSELL MD (NPI 1316688112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407852213 NPI number — SUSIE EARLY MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSIE EARLY MD PC
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:
ELIZABETH K. EARLY, MD
Provider Other Organization Name Type Code:
5
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:
1407852213
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 NORTH KEENE STREET
Provider Second Line Business Mailing Address:
SUITE 401
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-874-6984
Provider Business Mailing Address Fax Number:
573-874-8737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 NORTH KEENE STREET
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-874-6984
Provider Business Practice Location Address Fax Number:
573-874-8737
Provider Enumeration Date:
06/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
EARLY
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
573-874-6984

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , 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: 507255107 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 661525 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: DB8490 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 48602 . This is a "HEALTHCARE USA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 190084 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 497844546EAR . This is a "MERCY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com