1548226897 NPI number — ANN E BEHREND M.D.

Table of content: ANN E BEHREND M.D. (NPI 1548226897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548226897 NPI number — ANN E BEHREND M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEHREND
Provider First Name:
ANN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1548226897
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 843225
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64184-3225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-633-1234
Provider Business Mailing Address Fax Number:
708-342-7100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 S MOUNT AUBURN RD
Provider Second Line Business Practice Location Address:
SUITE 318
Provider Business Practice Location Address City Name:
CAPE GIRARDEAU
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63703-4910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-339-1166
Provider Business Practice Location Address Fax Number:
573-339-7166
Provider Enumeration Date:
04/25/2006

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: 207VX0000X , with the licence number:  R2D86 , 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: 107502 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1548226897 . This is a "TRIWEST" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 202030631 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 696274 . This is a "ANTHEM BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1548226897 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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