1508067208 NPI number — INTERVENTIONAL CENTER FOR PAIN

Table of content: (NPI 1508067208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508067208 NPI number — INTERVENTIONAL CENTER FOR PAIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERVENTIONAL CENTER FOR PAIN
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:
CENTER FOR INTERVENTIONAL PAIN MANAGEMENT
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:
1508067208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5203 CHIPPEWA ST
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63109-2356
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-481-5000
Provider Business Mailing Address Fax Number:
314-481-3037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5203 CHIPPEWA ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63109-2356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-481-5000
Provider Business Practice Location Address Fax Number:
314-481-3037
Provider Enumeration Date:
05/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PADDA
Authorized Official First Name:
GURPREET
Authorized Official Middle Name:
SINGH
Authorized Official Title or Position:
ANESTHESIOLOGY
Authorized Official Telephone Number:
314-481-5000

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 118505 . This is a "GHP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: CJ6421 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 175746 . This is a "HEALTH LINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2001272 . This is a "UHC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4647144 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 7200000096 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 149848 . This is a "BLUE CROSS BLE SHILED" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com