1669416046 NPI number — ANTHONY T TAY MD

Table of content: ANTHONY T TAY MD (NPI 1669416046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669416046 NPI number — ANTHONY T TAY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAY
Provider First Name:
ANTHONY
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1669416046
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29 NW 1ST LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAMAR
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64759-8105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-681-5248
Provider Business Mailing Address Fax Number:
417-681-5748

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3610 BUTTONWOOD DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65201-3721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-689-4080
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2006

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: 207RR0500X , with the licence number:  2003007573 , 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: 177676 . This is a "BLUE CROSS/BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 208975409 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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