1750590295 NPI number — PEARLETHA WASHINGTON, MD PC

Table of content: (NPI 1750590295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750590295 NPI number — PEARLETHA WASHINGTON, MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEARLETHA WASHINGTON, MD PC
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:
1750590295
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:
148 E PEARCE BLVD
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:
63385-1511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-704-9765
Provider Business Mailing Address Fax Number:
636-327-0058

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
148 E PEARCE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WENTZVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63385-1511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-704-9765
Provider Business Practice Location Address Fax Number:
636-327-0058
Provider Enumeration Date:
05/22/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WASHINGTON
Authorized Official First Name:
PEARLETHA
Authorized Official Middle Name:
ROZENIA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
636-357-7667

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD 108476 , 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)