1841278454 NPI number — THOMAS BRADLEY RIECHERS MD

Table of content: (NPI 1114148061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841278454 NPI number — THOMAS BRADLEY RIECHERS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIECHERS
Provider First Name:
THOMAS
Provider Middle Name:
BRADLEY
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:
1841278454
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
851 E 5TH ST
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63090-3135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-861-7870
Provider Business Mailing Address Fax Number:
636-861-7899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
851 E 5TH ST
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63090-3135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-861-7870
Provider Business Practice Location Address Fax Number:
636-861-7899
Provider Enumeration Date:
01/04/2006

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: 208600000X , with the licence number:  103197 , 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: 272481555 . This is a "GREAT WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 331394 . This is a "GROUP HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 3514 . This is a "HEALTHCARE USA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: P00640364 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 221032 . This is a "ANTHEM BLUE CROSS AND BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 272481555 . This is a "MULTIPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 206703100 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 888890 . This is a "MERCY CARE PLUS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 272481555 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 272481555 . This is a "HFN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 224979 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 272481555 . This is a "CHOICECARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4405391 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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