1013998152 NPI number — DEBORAH K MCDERMOTT M.D.

Table of content: DEBORAH K MCDERMOTT M.D. (NPI 1013998152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013998152 NPI number — DEBORAH K MCDERMOTT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDERMOTT
Provider First Name:
DEBORAH
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1013998152
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 23340
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:
63156-3340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-277-7500
Provider Business Mailing Address Fax Number:
618-277-4236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 PARK PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SWANSEA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62226-2965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-277-7500
Provider Business Practice Location Address Fax Number:
618-277-4236
Provider Enumeration Date:
11/07/2005

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: 207R00000X , with the licence number:  036-061906 , 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: 036061906 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0407153 . This is a "UHC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 000000010025 . This is a "ESSENCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 122607 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 2788 . This is a "BCBS TRI ST" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 4545931822 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08221955 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 127467 . This is a "GHP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 4227190 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: C45318 . This is a "MERCY" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com