1720041395 NPI number — JAMSHED GUL AGHA MD

Table of content: JAMSHED GUL AGHA MD (NPI 1720041395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720041395 NPI number — JAMSHED GUL AGHA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGHA
Provider First Name:
JAMSHED
Provider Middle Name:
GUL
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:
1720041395
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 MEDICAL DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WENTZVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-327-1202
Provider Business Mailing Address Fax Number:
636-327-1222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1475 KISKER RD
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
SAINT CHARLES
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63304-8781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-442-7300
Provider Business Practice Location Address Fax Number:
636-442-7319
Provider Enumeration Date:
04/06/2006

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: 207RH0003X , with the licence number:  2002016138 , 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: 1360100 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 173279 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5469243 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 900004419 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 205972300 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 143463 . This is a "GHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 633997 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".




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