1831182807 NPI number — DR. ROBERT G KOPITSKY MD

Table of content: DR. ROBERT G KOPITSKY MD (NPI 1831182807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831182807 NPI number — DR. ROBERT G KOPITSKY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOPITSKY
Provider First Name:
ROBERT
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
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:
1831182807
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3023 N BALLAS RD STE 200D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63131-2328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-996-7272
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3023 N BALLAS RD STE 200D
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:
63131-2328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-996-7272
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2005

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: 207RC0000X , with the licence number:  R4E32 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: R4E32 , 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: MA1080003 . This is a "CCL INDIVDUAL PROVIDER NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: P00275849 . This is a "CATHLAB RR MCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: MA1080 . This is a "CCL MEDICARE GROUP NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 002012762 . This is a "MEDICARE PROVIDER ID" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 060042993 . This is a "RR MEDICARE NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 000047049 . This is a "MCARE CCL GROUP NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 003013185 . This is a "MEDICARE PROV ID AREA 99" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: CD6536 . This is a "RR GROUP 01" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com