1902041114 NPI number — PEER REVIEW CONSULTING SERVICES, INC.

Table of content: (NPI 1902041114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902041114 NPI number — PEER REVIEW CONSULTING SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEER REVIEW CONSULTING SERVICES, INC.
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:
PERFORMANCE HEALTH OF ST LOUIS
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:
1902041114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11520 SAINT CHARLES ROCK RD
Provider Second Line Business Mailing Address:
STE 202
Provider Business Mailing Address City Name:
BRIDGETON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63044-2732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-291-5077
Provider Business Mailing Address Fax Number:
314-739-4169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11520 SAINT CHARLES ROCK RD
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
BRIDGETON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63044-2732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-291-5077
Provider Business Practice Location Address Fax Number:
314-739-4169
Provider Enumeration Date:
12/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HEEB
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
314-291-5077

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  006159 , 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)





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