1417453812 NPI number — ANN M HILS PHARM.D., BCPS

Table of content: ANN M HILS PHARM.D., BCPS (NPI 1417453812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417453812 NPI number — ANN M HILS PHARM.D., BCPS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILS
Provider First Name:
ANN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D., BCPS
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:
1417453812
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
907 N MORLEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBERLY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65270-2610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-263-4457
Provider Business Mailing Address Fax Number:
660-263-4456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
907 N MORLEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBERLY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65270-2610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-263-4457
Provider Business Practice Location Address Fax Number:
660-263-4456
Provider Enumeration Date:
04/04/2018

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: 1835P1200X , with the licence number:  3130814 , 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: 1205357308 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1174929723 . This is a "COMMERCIAL INSURANCE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1174929723 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1023568078 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 600018685 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1023568278 . This is a "COMMERCIAL INSURANCE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 600037573 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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