1811044233 NPI number — MICHELE ANN ROBERTS, PC

Table of content: (NPI 1811044233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811044233 NPI number — MICHELE ANN ROBERTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHELE ANN ROBERTS, 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:
1811044233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6209 MID RIVERS MALL DR
Provider Second Line Business Mailing Address:
#317
Provider Business Mailing Address City Name:
SAINT PETERS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63304-1102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-294-5735
Provider Business Mailing Address Fax Number:
636-294-1566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6209 MID RIVERS MALL DR
Provider Second Line Business Practice Location Address:
#317
Provider Business Practice Location Address City Name:
SAINT PETERS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63304-1102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-294-5735
Provider Business Practice Location Address Fax Number:
636-294-1566
Provider Enumeration Date:
01/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTS
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
GERIATRIC NURSE PRACTITIONER
Authorized Official Telephone Number:
636-294-5735

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  103362 , 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: DB9981 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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