1306838156 NPI number — MELINDA S WALKER DO

Table of content: MELINDA S WALKER DO (NPI 1306838156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306838156 NPI number — MELINDA S WALKER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKER
Provider First Name:
MELINDA
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1306838156
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
311 W LINCOLN ST
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
BELLEVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62220-1902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-234-2566
Provider Business Mailing Address Fax Number:
618-234-5650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 W LINCOLN ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62220-1902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-234-2566
Provider Business Practice Location Address Fax Number:
618-234-5650
Provider Enumeration Date:
08/18/2005

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: 207Q00000X , with the licence number:  036-088446 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 166423 . This is a "GROUP HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 23934 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5746595 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 983310100 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1159459 . This is a "UNITED HEALTHCARE/COMMERCIAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 678480001 . This is a "DMERC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 80057275 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 250243 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com