1902814866 NPI number — PARKLAND HEALTH CENTER

Table of content: (NPI 1902814866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902814866 NPI number — PARKLAND HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARKLAND HEALTH CENTER
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:
PARKLAND HEALTH CENTER - FARMINGTON
Provider Other Organization Name Type Code:
3
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:
1902814866
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
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:
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:
573-756-1408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 W LIBERTY ST
Provider Second Line Business Practice Location Address:
SENIOR SUPPORT CENTER
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63640-1921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-756-6451
Provider Business Practice Location Address Fax Number:
573-756-1408
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHNABEL
Authorized Official First Name:
ANNETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
573-760-8280

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  379-13 , 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: 010638203 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 119 . This is a "BLUE CROSS-BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 856X8562 . This is a "HEALTHCARE USA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 182901 . This is a "HEALTH LINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 260163 . This is a "MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 260163 . This is a "MERCY MC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5020035 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 999681 . This is a "COMMUNITY CARE PLUS" identifier . This identifiers is of the category "OTHER".




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