1912466186 NPI number — MS. ELIZABETH D MUELLER AUD

Table of content: MS. ELIZABETH D MUELLER AUD (NPI 1912466186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912466186 NPI number — MS. ELIZABETH D MUELLER AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUELLER
Provider First Name:
ELIZABETH
Provider Middle Name:
D
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
AUD
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:
1912466186
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/30/2020
NPI Reactivation Date:
11/10/2020

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
660 S EUCLID AVE
Provider Second Line Business Mailing Address:
CB 8115
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63110-1010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-362-7509
Provider Business Mailing Address Fax Number:
314-362-7522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 WOLF CREEK DR
Provider Second Line Business Practice Location Address:
DEPT OTOLARYNGOLOGY
Provider Business Practice Location Address City Name:
SWANSEA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62226-2355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-235-3687
Provider Business Practice Location Address Fax Number:
618-239-9429
Provider Enumeration Date:
03/18/2019

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: 231H00000X , with the licence number:  147001778 , 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: 200101428 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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