1184861478 NPI number — CAL W GREENLAW MD PC

Table of content: DR. CHRISTOPHER PODGORSKI MATTHEWS D.O (NPI 1700825916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184861478 NPI number — CAL W GREENLAW MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAL W GREENLAW 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:
1184861478
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 11TH ST
Provider Second Line Business Mailing Address:
SUITE 16
Provider Business Mailing Address City Name:
CHILLICOTHEE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64601-1676
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-646-4345
Provider Business Mailing Address Fax Number:
660-646-6024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 11TH ST
Provider Second Line Business Practice Location Address:
SUITE 16
Provider Business Practice Location Address City Name:
CHILLICOTHEE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64601-1676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-646-4345
Provider Business Practice Location Address Fax Number:
660-646-6024
Provider Enumeration Date:
01/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GREENLAW
Authorized Official First Name:
CAL
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
660-646-4345

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  R3F02 , 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)





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