1154399145 NPI number — DR. RODNEY D ZIMBELMAN MD

Table of content: DR. RODNEY D ZIMBELMAN MD (NPI 1154399145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154399145 NPI number — DR. RODNEY D ZIMBELMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZIMBELMAN
Provider First Name:
RODNEY
Provider Middle Name:
D
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:
1154399145
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST PLAINS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65775-1100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-257-6782
Provider Business Mailing Address Fax Number:
417-257-5947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 N KENTUCKY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PLAINS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65775-2029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-256-9111
Provider Business Practice Location Address Fax Number:
417-257-5916
Provider Enumeration Date:
03/08/2006

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: 207L00000X , with the licence number:  117735 , 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: 1154399145 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 199497001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 050082167 . This is a "RRB" identifier . This identifiers is of the category "OTHER".