1144214297 NPI number — DR. STEPHEN J PIEPER MD

Table of content: DR. STEPHEN J PIEPER MD (NPI 1144214297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144214297 NPI number — DR. STEPHEN J PIEPER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIEPER
Provider First Name:
STEPHEN
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
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:
1144214297
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 N NEW BALLAS RD
Provider Second Line Business Mailing Address:
STE 270 W
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63141-6835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-991-6969
Provider Business Mailing Address Fax Number:
314-997-6969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 N NEW BALLAS RD
Provider Second Line Business Practice Location Address:
STE 270 W
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141-6835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-991-6969
Provider Business Practice Location Address Fax Number:
314-997-6969
Provider Enumeration Date:
09/06/2005

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: 207RC0000X , with the licence number:  R5N46 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 34928 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 036-093138 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0001X , with the licence number: 138830 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0001X , with the licence number: R5N46 , 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: 005013185 . This is a "MEDICARE PROV ID AREA 99" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 000047049 . This is a "MCARE CCL GROUP NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1144214297 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004012762 . This is a "MEDICARE PROVIDER ID" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: CD6536 . This is a "RR GROUP 01" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 990002433 . This is a "RR MEDICARE NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: CI7050 . This is a "RR GROUP 99" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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