1871989376 NPI number — PARKLAND HEALTH CENTER - WEBER ROAD

Table of content: (NPI 1871989376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871989376 NPI number — PARKLAND HEALTH CENTER - WEBER ROAD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARKLAND HEALTH CENTER - WEBER ROAD
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:
1871989376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 W LIBERTY ST
Provider Second Line Business Mailing Address:
ADMINISTRATION
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63640-1921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-756-6451
Provider Business Mailing Address Fax Number:
573-756-9742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1212 WEBER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63640-3325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-756-4581
Provider Business Practice Location Address Fax Number:
573-756-5834
Provider Enumeration Date:
04/10/2015

Additional Information

Authorized Official

Authorized Official Last Name:
KARL
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
573-760-8275

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  803-7HH , 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: 580364806 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com