1467518464 NPI number — EASTERN MISSOURI GENERAL SERVICES INC

Table of content: (NPI 1467518464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467518464 NPI number — EASTERN MISSOURI GENERAL SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN MISSOURI GENERAL SERVICES INC
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:
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:
1467518464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
322 NO STATE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DESLOGE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63601-3052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-431-4510
Provider Business Mailing Address Fax Number:
573-431-4790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
322 NO STATE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DESLOGE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63601-3052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-431-4510
Provider Business Practice Location Address Fax Number:
573-431-4790
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SECOR
Authorized Official First Name:
RIOHARD
Authorized Official Middle Name:
MARTIN
Authorized Official Title or Position:
PRESIDENT PHYSICIAN
Authorized Official Telephone Number:
573-431-4510

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  R9A44 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 10179 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0130013 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101430 . This is a "HL HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 103 . This is a "GHP GROUP HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 04232001 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 25000 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4384846 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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