1699847699 NPI number — REBECCA BADGEROW-WATSON MPT,OCS

Table of content: REBECCA BADGEROW-WATSON MPT,OCS (NPI 1699847699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699847699 NPI number — REBECCA BADGEROW-WATSON MPT,OCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BADGEROW-WATSON
Provider First Name:
REBECCA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPT,OCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BADGEROW
Provider Other First Name:
REBECCA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MPT,OCS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1699847699
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
236 SOUTHWOODS CTR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62236-2462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-281-0374
Provider Business Mailing Address Fax Number:
618-281-0674

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
236 SOUTHWOODS CTR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62236-2462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-281-0374
Provider Business Practice Location Address Fax Number:
618-281-0674
Provider Enumeration Date:
11/14/2006

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: 2251X0800X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 277645 . This is a "GHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5660579 . This is a "FIRST HEALTH CCN" identifier . This identifiers is of the category "OTHER".
  • Identifier: K23120 . This is a "MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 06732025 . This is a "BCBS OF IL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7361646 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 737359 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9419162 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 205903 . This is a "BCBS OF MO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13897 . This is a "ESSENCE HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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