1083621155 NPI number — JOHN H NIEMEYER MD

Table of content: JOHN H NIEMEYER MD (NPI 1083621155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083621155 NPI number — JOHN H NIEMEYER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIEMEYER
Provider First Name:
JOHN
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1083621155
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 WESTPORT PLZ
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63146-3109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-548-4772
Provider Business Mailing Address Fax Number:
314-548-4748

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3015 N NEW BALLAS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-996-5180
Provider Business Practice Location Address Fax Number:
314-821-2180
Provider Enumeration Date:
08/02/2006

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: 2085R0202X , with the licence number:  R4F79 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 036108453 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 003013128 . This is a "CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 398022 . This is a "HLT PART" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431725842MID . This is a "MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6707 . This is a "HCARE USA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 008012444 . This is a "MO CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101033 . This is a "H LINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1078154 . This is a "MC MCAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: A12511 . This is a "GATE WAY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300066988 . This is a "RR CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003013128 . This is a "MO CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 008012444 . This is a "CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1650514 . This is a "PH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 28081 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2781 . This is a "GHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0090000352 . This is a "IL BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1390 . This is a "MO BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202282406 . This is a "MO CAID" identifier . This identifiers is of the category "OTHER".




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