1205830023 NPI number — JAMES BRUCE PITT D.O.

Table of content: CHRISTOPHER DREW (NPI 1164188892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205830023 NPI number — JAMES BRUCE PITT D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PITT
Provider First Name:
JAMES
Provider Middle Name:
BRUCE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1205830023
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3220 BLUFF CREEK DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65201-3525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-443-8773
Provider Business Mailing Address Fax Number:
573-443-6843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3220 BLUFF CREEK DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65201-3525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-443-8773
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2005

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: 208600000X , with the licence number:  36954 , 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: 28058 . This is a "GHP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 3481 . This is a "HEALTHCARE USA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 431428562 . This is a "GREAT WEST" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 21957 . This is a "ANTHEM BLUECROSS BLUESHIE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 246644900 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4343705 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: E96533 . This is a "MERCY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 9134339 . This is a "PHCS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1284517 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 238659 . This is a "HEALTHLINK, INC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com