1568634533 NPI number — KATHERINE LYNNE GARLAND M.D.

Table of content: KATHERINE LYNNE GARLAND M.D. (NPI 1568634533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568634533 NPI number — KATHERINE LYNNE GARLAND M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARLAND
Provider First Name:
KATHERINE
Provider Middle Name:
LYNNE
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:
PUETZ
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
LYNNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568634533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 S NEW BALLAS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63141-8221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-251-6382
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
621 S NEW BALLAS RD
Provider Second Line Business Practice Location Address:
TOWER B, SUITE 3016
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141-8232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-251-6339
Provider Business Practice Location Address Fax Number:
314-251-4564
Provider Enumeration Date:
03/29/2008

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: 208M00000X , with the licence number:  2010014295 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 2010014295 , 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: 1568634533 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1568634533 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01204276 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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