1124185772 NPI number — ROBERT L CARTER MD PC

Table of content: (NPI 1124185772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124185772 NPI number — ROBERT L CARTER MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT L CARTER MD PC
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:
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:
1124185772
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1617 W 26TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOPLIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64804-0322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-623-7700
Provider Business Mailing Address Fax Number:
417-623-0565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1617 W 26TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-623-7700
Provider Business Practice Location Address Fax Number:
417-623-0565
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARTER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
LEONARD
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
417-623-7700

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 505214601 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000010654 . This is a "ANTHEM BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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