1891962312 NPI number — INSTITUTE FOR BEAUTY AND WOMENS HEALTH LLC

Table of content: (NPI 1891962312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891962312 NPI number — INSTITUTE FOR BEAUTY AND WOMENS HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
INSTITUTE FOR BEAUTY AND WOMENS HEALTH LLC
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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1891962312
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
590 W PACIFIC
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANSON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65616-0590
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-335-2080
Provider Business Mailing Address Fax Number:
417-336-3583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
590 W PACIFIC
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRANSON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65616-0590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-335-2080
Provider Business Practice Location Address Fax Number:
417-336-3583
Provider Enumeration Date:
05/14/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NEIMARK
Authorized Official First Name:
ROY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
417-335-2080

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW000939 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 120158 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 35042 , 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: 1891962312 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1295733103 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".