1811981715 NPI number — SCOTT A KIRCHNER MD

Table of content: SCOTT A KIRCHNER MD (NPI 1811981715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811981715 NPI number — SCOTT A KIRCHNER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIRCHNER
Provider First Name:
SCOTT
Provider Middle Name:
A
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:
1811981715
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6555 CHIPPEWA ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63109-4110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-645-8719
Provider Business Mailing Address Fax Number:
314-645-8642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6555 CHIPPEWA ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63109-4110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-645-8719
Provider Business Practice Location Address Fax Number:
314-645-8642
Provider Enumeration Date:
09/07/2005

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: 207R00000X , with the licence number:  R3C11 , 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: BLC9364 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10468 . This is a "ESSENCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431269659 . This is a "MISCELLANEOUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5453 . This is a "ONE HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 181250 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 26D0438468 . This is a "CLIA WAIVER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110005208 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3258644 . This is a "PHCS HEALTH MARKET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9364 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: A11500 . This is a "MERCY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0400231 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33594 . This is a "GHP" identifier . This identifiers is of the category "OTHER".




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