1578510954 NPI number — EDWIN J CUNNINGHAM M.D.

Table of content: EDWIN J CUNNINGHAM M.D. (NPI 1578510954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578510954 NPI number — EDWIN J CUNNINGHAM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUNNINGHAM
Provider First Name:
EDWIN
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1578510954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9434
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65801-9434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-885-3888
Provider Business Mailing Address Fax Number:
417-881-7638

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3801 S NATIONAL AVE
Provider Second Line Business Practice Location Address:
WEST TOWER, SUITE 700
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65807-5210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-885-3888
Provider Business Practice Location Address Fax Number:
417-881-7638
Provider Enumeration Date:
05/30/2006

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: 207T00000X , with the licence number:  E4587 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X , with the licence number: 82517 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X , with the licence number: 2005013024 , 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: 0215052 . This is a "DEPARTMENT OF LABOR WA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 106461 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: H91289 . This is a "USPS (W/C)" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 23274 . This is a "COX HEALTH PLANS UPI" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5N434 . This is a "ARKANSAS BC/BS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 5N434 . This is a "ARKANSAS FIRST SOURCE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 6060020300 . This is a "QUAL CHOICE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 207278102 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5N434 . This is a "HEALTH ADVANTAGE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 8719997003 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 198370 . This is a "BLUE CROSS/CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2305711 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 159350001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4188130001 . This is a "CIGNA MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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