1205946787 NPI number — ORAL AND MAXILLOFACIAL SURGEONS INC

Table of content: (NPI 1205946787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205946787 NPI number — ORAL AND MAXILLOFACIAL SURGEONS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORAL AND MAXILLOFACIAL SURGEONS INC
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:
1205946787
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
456 N NEW BALLAS RD
Provider Second Line Business Mailing Address:
SUITE 249
Provider Business Mailing Address City Name:
CREVE COEUR
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63141-6831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-569-2201
Provider Business Mailing Address Fax Number:
314-569-2320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
456 N NEW BALLAS RD
Provider Second Line Business Practice Location Address:
SUITE 249
Provider Business Practice Location Address City Name:
CREVE COEUR
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141-6831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-569-2201
Provider Business Practice Location Address Fax Number:
314-569-2320
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KRAM
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
E
Authorized Official Title or Position:
ORAL SURGEON
Authorized Official Telephone Number:
314-569-2201

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  13560 , 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: T70963 . This is a "MEDICARE ID- TYPE UNSPECIFIED- DR KRAM" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 111519 . This is a "CIGNA HMO DR ABRAMS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 111520 . This is a "CIGNA HMO DR KRAM" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 29075 . This is a "BCBS MED DR ABRAMS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 29086 . This is a "BCBS MED DR KRAM" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: T80996 . This is a "MEDICARE ID- TYPE UNSPECIFIED- DR ABRAMS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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