1255543047 NPI number — MALAZ SAFI, M.D., P.C.

Table of content: (NPI 1255543047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255543047 NPI number — MALAZ SAFI, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MALAZ SAFI, M.D., P.C.
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:
ADVANCED EYE CARE CENTER
Provider Other Organization Name Type Code:
3
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:
1255543047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8790 WATSON RD STE 203
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:
63119-5140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-543-2850
Provider Business Mailing Address Fax Number:
314-543-2851

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8790 WATSON RD STE 203
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:
63119-5140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-543-2850
Provider Business Practice Location Address Fax Number:
314-543-2851
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SAFI
Authorized Official First Name:
MALAZ
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
314-543-2850

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  R9B71 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X , with the licence number: 336-031037 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 500046701 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 296746824 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: DD3116 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 0269280001 . This is a "NATIONAL GOVERNMENT SERVI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: DC5331 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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