1104137173 NPI number — HERITAGE POINTE PARTNERS LLC

Table of content: (NPI 1104137173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104137173 NPI number — HERITAGE POINTE PARTNERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HERITAGE POINTE PARTNERS 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:
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:
1104137173
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
228 SAVANNAH TERRACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WENTZVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63385-3741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-542-5400
Provider Business Mailing Address Fax Number:
636-542-5520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
228 SAVANNAH TERRACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WENTZVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63385-3741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-542-5400
Provider Business Practice Location Address Fax Number:
636-542-5520
Provider Enumeration Date:
06/24/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BLATTEL
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
636-240-6152

Provider Taxonomy Codes

  • Taxonomy code: 311500000X , with the licence number:  038114 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: 038114 , 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)