1689677106 NPI number — DR. EUGENE J MCCABE M.D.

Table of content: DR. EUGENE J MCCABE M.D. (NPI 1689677106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689677106 NPI number — DR. EUGENE J MCCABE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCABE
Provider First Name:
EUGENE
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
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:
1689677106
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1005 FAIRGROUNDS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CHARLES
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63301-2338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-724-7116
Provider Business Mailing Address Fax Number:
636-916-4627

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1005 FAIRGROUNDS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT CHARLES
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63301-2338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-724-7116
Provider Business Practice Location Address Fax Number:
636-916-4627
Provider Enumeration Date:
05/30/2005

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: 207W00000X , with the licence number:  R9550 , 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: 11946 . This is a "OPTICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 8035 . This is a "EXCLUSIVE CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2235 . This is a "GHP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 22466 . This is a "BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 0951302 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 100995 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 0800026 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4000687 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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