1215291604 NPI number — RACHEL ALT MD

Table of content: RACHEL ALT MD (NPI 1215291604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215291604 NPI number — RACHEL ALT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALT
Provider First Name:
RACHEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1215291604
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE HOSPITAL DRIVE, DCO75.00, MC424
Provider Second Line Business Mailing Address:
UNIVERSITY OF MISSOURI, DEPARTMENT OF SURGERY
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-884-2000
Provider Business Mailing Address Fax Number:
573-884-6024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5994 S HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLOBE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85501-9462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-425-7108
Provider Business Practice Location Address Fax Number:
928-425-7925
Provider Enumeration Date:
06/29/2012

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:  2012017801 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 58890 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 005495 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2012017801 . This is a "MEDICAL LICENSE NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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