1427011808 NPI number — MILTON R. EICHMANN M.D., PSC

Table of content: MRS. LAUREN HURLBUT M.S. CCC-SLP (NPI 1609029859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427011808 NPI number — MILTON R. EICHMANN M.D., PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILTON R. EICHMANN M.D., PSC
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:
BLUFF UROLOGY 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:
1427011808
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2530 LUCY LEE PKWY STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POPLAR BLUFF
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63901-2436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-686-7575
Provider Business Mailing Address Fax Number:
573-686-5199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2530 LUCY LEE PKWY STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POPLAR BLUFF
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63901-2436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-686-7575
Provider Business Practice Location Address Fax Number:
573-686-5199
Provider Enumeration Date:
04/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EICHMANN
Authorized Official First Name:
MILTON
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
573-686-7575

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  2003026717 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0774800001 . This is a "DME NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 506149400 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".