1255395687 NPI number — DR. ALAA A ELBENDARY M.D.

Table of content: DR. ALAA A ELBENDARY M.D. (NPI 1255395687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255395687 NPI number — DR. ALAA A ELBENDARY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELBENDARY
Provider First Name:
ALAA
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1255395687
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11652 STUDT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63141-7025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-991-5445
Provider Business Mailing Address Fax Number:
314-991-5447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11652 STUDT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141-7025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-991-5445
Provider Business Practice Location Address Fax Number:
314-991-5447
Provider Enumeration Date:
04/13/2006

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: 207VX0201X , with the licence number:  110171 , 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: 412030177 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33810 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 7407000 . This is a "MEDICARE COMPLETE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: P00330196 . This is a "RR MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 33180 . This is a "BLUE CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: F82867 . This is a "MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 027213 . This is a "FMH EXCLUSIVE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 288803 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 412030177 . This is a "GREAT WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 121918 . This is a "ADVANTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 121918 . This is a "GROUP HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 121918 . This is a "CMR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 412030177 . This is a "GOLDEN RULE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 412030177 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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