1619981685 NPI number — COMPREHENSIVE CARDIOVASCULAR CONSULTANTS, INC.

Table of content: (NPI 1619981685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619981685 NPI number — COMPREHENSIVE CARDIOVASCULAR CONSULTANTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE CARDIOVASCULAR CONSULTANTS, 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:
COMPREHENSIVE CARDIOVASCULAR CONSULTANTS, INC.
Provider Other Organization Name Type Code:
5
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:
1619981685
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3760 S LINDBERGH BLVD
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:
63127-1358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-849-0923
Provider Business Mailing Address Fax Number:
314-849-5716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3760 S LINDBERGH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63127-1358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-849-0923
Provider Business Practice Location Address Fax Number:
314-849-5716
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
GWENDOLYN
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
314-849-0923

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  MDR4P45 , 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: MA1561 . This is a "MEDICARE PTAN EASTERN MO IDTF" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: IL1797 . This is a "IL IDTF FOR COLUMBIA & NEW BADEN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 409407 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: DG2079 . This is a "RAILROAD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: MA1570 . This is a "MEDICARE PTAN WESTERN MO IDTF" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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