1194376640 NPI number — KATHARINE MCGINNIS D.M.D. P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194376640 NPI number — KATHARINE MCGINNIS D.M.D. P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATHARINE MCGINNIS D.M.D. P.C.
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:
1194376640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
235 A. SOUTH MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDWARDSVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-656-0451
Provider Business Mailing Address Fax Number:
618-656-9130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
235 A. SOUTH MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDWARDSVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-656-0451
Provider Business Practice Location Address Fax Number:
618-656-9130
Provider Enumeration Date:
09/26/2019

Additional Information

Authorized Official

Authorized Official Last Name:
MCGINNIS
Authorized Official First Name:
KATHARINE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
618-656-0451

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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