1710981444 NPI number — JOHN GRAMLING ADAMS JR. M.D.

Table of content: JOHN GRAMLING ADAMS JR. M.D. (NPI 1710981444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710981444 NPI number — JOHN GRAMLING ADAMS JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADAMS
Provider First Name:
JOHN
Provider Middle Name:
GRAMLING
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
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:
1710981444
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3220 BLUFF CREEK DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65201-3663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-443-8773
Provider Business Mailing Address Fax Number:
573-443-6843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3220 BLUFF CREEK DR
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65201-3663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-443-8773
Provider Business Practice Location Address Fax Number:
573-443-6843
Provider Enumeration Date:
06/10/2005

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: 208600000X , with the licence number:  103971 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 103971 , 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: 1980317 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: G02433 . This is a "MERCY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 207974908 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 431428562 . This is a "GREAT WEST" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5410082 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 28058 . This is a "GHP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 19973 . This is a "HEALTHCARE USA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 273734 . This is a "HEALTHLINK, INC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 20157 . This is a "ANTHEM BLUECROSS BLUESHIE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 9134342 . This is a "PHCS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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