1063706778 NPI number — QI ENTERPRISES

Table of content: MEGAN CORRY PT, DPT (NPI 1184048829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063706778 NPI number — QI ENTERPRISES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QI ENTERPRISES
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:
Provider Other Organization Name Type Code:
6
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:
1063706778
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 TRIAD CENTER WEST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
O'FALLON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63366-7542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-240-6533
Provider Business Mailing Address Fax Number:
636-980-3470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 TRIAD CENTER WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
O'FALLON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63366-7542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-240-6533
Provider Business Practice Location Address Fax Number:
636-980-3470
Provider Enumeration Date:
05/31/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ARNOLD
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
ERIC
Authorized Official Title or Position:
DIRECTOR OF OPERATION
Authorized Official Telephone Number:
314-480-2608

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , 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)