1891731832 NPI number — CHRISTOPHER J MEOLI DO

Table of content: CHRISTOPHER J MEOLI DO (NPI 1891731832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891731832 NPI number — CHRISTOPHER J MEOLI DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEOLI
Provider First Name:
CHRISTOPHER
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1891731832
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35800 BOB HOPE DR
Provider Second Line Business Mailing Address:
INTERVENTIONAL RADIOLOGY AND IMAGING CENTER, SUITE 150
Provider Business Mailing Address City Name:
RANCHO MIRAGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92270-1739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-770-1920
Provider Business Mailing Address Fax Number:
760-324-0848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35800 BOB HOPE DR
Provider Second Line Business Practice Location Address:
INTERVENTIONAL RADIOLOGY AND IMAGING CENTER, SUITE 150
Provider Business Practice Location Address City Name:
RANCHO MIRAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92270-1739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-770-1920
Provider Business Practice Location Address Fax Number:
760-324-0848
Provider Enumeration Date:
06/20/2006

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: 2085R0202X , with the licence number:  34435 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: 20A 10654 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 20A 10654 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 117809 . This is a "MO BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223318 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100016850B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100230830B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 240912071 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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