1033160122 NPI number — BDM ASSOCIATES LLC

Table of content: (NPI 1033160122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033160122 NPI number — BDM ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BDM ASSOCIATES LLC
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:
PEAK PERFORMANCE PHYSICAL THERAPY & SPORTS MEDICINE
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:
1033160122
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2902 FORUM BLVD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65203-0992
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-442-5268
Provider Business Mailing Address Fax Number:
573-442-5278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3301 BERRYWOOD DR
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65201-6517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-449-8771
Provider Business Practice Location Address Fax Number:
573-449-6563
Provider Enumeration Date:
05/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REEDER
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DIRECTOR OF BILLING
Authorized Official Telephone Number:
573-449-6082

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 834765000 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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