1205052727 NPI number — DR ARDEKANIS STRESS CLINIC, PC

Table of content: (NPI 1205052727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205052727 NPI number — DR ARDEKANIS STRESS CLINIC, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR ARDEKANIS STRESS CLINIC, 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:
1205052727
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10004 KENNERLY RD
Provider Second Line Business Mailing Address:
SUITE 310A
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63128-2141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-843-3310
Provider Business Mailing Address Fax Number:
314-843-8825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SUITE 310A
Provider Second Line Business Practice Location Address:
10004 KENNERLY RD
Provider Business Practice Location Address City Name:
ST LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63128-5117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-843-3310
Provider Business Practice Location Address Fax Number:
314-843-8825
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ARDEKANI
Authorized Official First Name:
AHMAD
Authorized Official Middle Name:
BEHESHTI
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
314-843-3310

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  35941 , 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: 181942 . This is a "ALLIANCE BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 260004802498769 . This is a "TRICARE NORTH REGION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 504612003 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 260004802 . This is a "RR MEDICARE PART B" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12031 . This is a "CIGNA GENERAL MOTORS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31744 . This is a "CMR CARE MANAGEMENT RESOU" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9534 . This is a "BCBS OF MISSOURI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 015927000 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101010 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 129999 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: A10513 . This is a "MERCY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31744 . This is a "GROUP HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1542794 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 198301 . This is a "VALUE BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".




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