1689890394 NPI number — ASPIRE INTERNAL MEDICINE, L.L.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689890394 NPI number — ASPIRE INTERNAL MEDICINE, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASPIRE INTERNAL MEDICINE, L.L.C.
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:
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:
1689890394
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 BUCKHURST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALLWIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63021-8346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-527-9141
Provider Business Mailing Address Fax Number:
636-583-8559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 US HIGHWAY 50 W
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
UNION
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63084-1970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-583-8555
Provider Business Practice Location Address Fax Number:
636-583-8559
Provider Enumeration Date:
04/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAUERLE
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
DIANE
Authorized Official Title or Position:
OWNER AND SOLE PROPRIETOR
Authorized Official Telephone Number:
636-527-9141

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  2006015211 , 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)





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