1861088270 NPI number — AMEANNA VUSU HAMILTON

Table of content: AMEANNA VUSU HAMILTON (NPI 1861088270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861088270 NPI number — AMEANNA VUSU HAMILTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMILTON
Provider First Name:
AMEANNA
Provider Middle Name:
VUSU
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1861088270
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6500 OLD MISSOURI AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTREVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62207-2356
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-857-2170
Provider Business Mailing Address Fax Number:
618-857-2170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6500 OLD MISSOURI AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTREVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62207-2356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-857-2170
Provider Business Practice Location Address Fax Number:
618-857-2170
Provider Enumeration Date:
12/19/2020

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: 171M00000X , with the licence number:  3001843 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3001843 . This is a "HOMECARE SERVICE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".