1437109626 NPI number — KATHARINE M CONABLE DC

Table of content: KATHARINE M CONABLE DC (NPI 1437109626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437109626 NPI number — KATHARINE M CONABLE DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONABLE
Provider First Name:
KATHARINE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1437109626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8229 CLAYTON RD
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63117-1155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-991-5655
Provider Business Mailing Address Fax Number:
314-932-5080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8229 CLAYTON RD
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:
63117-1155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-991-5655
Provider Business Practice Location Address Fax Number:
314-932-5080
Provider Enumeration Date:
05/11/2006

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: 111N00000X , with the licence number:  3930 , 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: 4582036 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 084722 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 350033156 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54143 . This is a "GROUP HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 990001765 . This is a "RR MEDICARE GROUP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5074 . This is a "BLUE CROSS BS OF MO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3930 . This is a "LICENSE #" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 431260519 . This is a "FEDERAL TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 178246 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431260519CON . This is a "MERCY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: EMPIRE BLUE CROSS . This is a "10146X" identifier . This identifiers is of the category "OTHER".




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