1750303335 NPI number — JOHN T ENGELS MD

Table of content: JOHN T ENGELS MD (NPI 1750303335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750303335 NPI number — JOHN T ENGELS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENGELS
Provider First Name:
JOHN
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:
1750303335
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 WESTPORT PLZ
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63146-3109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-548-4772
Provider Business Mailing Address Fax Number:
314-548-4748

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3015 N NEW BALLAS RD
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:
63131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-996-5180
Provider Business Practice Location Address Fax Number:
314-821-2180
Provider Enumeration Date:
07/24/2006

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: 2085R0202X , with the licence number:  R5H85 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 036112438 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1390 . This is a "MO BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5777 . This is a "HCARE USA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100569 . This is a "H LINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202673208 . This is a "MC MCAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 16850 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300066991 . This is a "RR CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202673208 . This is a "MO CAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 020012444 . This is a "MO CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431725842MID . This is a "MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: E39928 . This is a "GATE WAY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1600224 . This is a "PH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2781 . This is a "GHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300066984 . This is a "RR CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 014013128 . This is a "MO CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0006021895 . This is a "IL BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 020012444 . This is a "CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 398025 . This is a "HLT PART" identifier . This identifiers is of the category "OTHER".




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