1043288483 NPI number — WILLIAM F CUNNINGHAM M.D.

Table of content: WILLIAM F CUNNINGHAM M.D. (NPI 1043288483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043288483 NPI number — WILLIAM F CUNNINGHAM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUNNINGHAM
Provider First Name:
WILLIAM
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
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:
1043288483
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10140 E STATE HIGHWAY D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROGERSVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65742-7534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3850 S NATIONAL AVE
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65807-5287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-882-4880
Provider Business Practice Location Address Fax Number:
417-882-7843
Provider Enumeration Date:
03/10/2006

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: 207RX0202X , with the licence number:  R7D69 , 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: 110042512 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 25578 . This is a "ANTHEM BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 0628420001 . This is a "DMERC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 202165205 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3640000 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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