1952392359 NPI number — SUPPLEMENTAL MEDICAL SERVICES

Table of content: (NPI 1952392359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952392359 NPI number — SUPPLEMENTAL MEDICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUPPLEMENTAL MEDICAL SERVICES
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:
STAFFLINK
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:
1952392359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10916 SCHUETZ RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63146-5704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-997-8833
Provider Business Mailing Address Fax Number:
314-997-3115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10916 SCHUETZ RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63146-5704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-997-8833
Provider Business Practice Location Address Fax Number:
314-997-3115
Provider Enumeration Date:
11/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CURRY
Authorized Official First Name:
GRETCHEN
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
314-997-8833

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 855168407 . This is a "DEPARTMENT MENTAL HEALTH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 942269101 . This is a "PRIVATE DUTY NURSING MO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 262269103 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 282269109 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 44281 . This is a "HEALTH CARE USA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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