1760647218 NPI number — BABAR ENTERPRISES LLC

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 1760647218 NPI number — BABAR ENTERPRISES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BABAR ENTERPRISES LLC
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:
6
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:
1760647218
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2454 W CLAY ST
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:
63301-2548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-916-4625
Provider Business Mailing Address Fax Number:
636-916-4628

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1096 TOM GINNEVER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
O FALLON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63366-4519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-978-5255
Provider Business Practice Location Address Fax Number:
636-978-5287
Provider Enumeration Date:
07/24/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DAVIDSON
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OWNER / AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
616-356-5000

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5234 , 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)