1184927303 NPI number — EVAN T BELFER MD SC

Table of content: (NPI 1184927303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184927303 NPI number — EVAN T BELFER MD SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVAN T BELFER MD SC
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:
1184927303
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 N 14TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURPHYSBORO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62966-1611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-687-2319
Provider Business Mailing Address Fax Number:
618-684-3321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 N 14TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURPHYSBORO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62966-1611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-687-2319
Provider Business Practice Location Address Fax Number:
618-684-3321
Provider Enumeration Date:
12/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BELFER
Authorized Official First Name:
EVAN
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
618-687-2319

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  036-107906 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 078338 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 431741 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 039-32006 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 614634500 . This is a "DEPARTMENT OF LABOR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 080191627 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036-107906 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com