1952345795 NPI number — SAM HAWATMEH, M D, P C

Table of content: (NPI 1952345795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952345795 NPI number — SAM HAWATMEH, M D, P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAM HAWATMEH, M D, P C
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:
1952345795
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6651 CHIPPEWA ST
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63109-2538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-645-8200
Provider Business Mailing Address Fax Number:
314-645-8244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6651 CHIPPEWA ST
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63109-2538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-645-8200
Provider Business Practice Location Address Fax Number:
314-645-8244
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAWATMEH
Authorized Official First Name:
ISAM
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
314-645-8200

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1125337 . This is a "FIRST HORIZON" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 125694 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 178V178 . This is a "GHP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: CG6708 . This is a "RRMCR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 178V178 . This is a "CMR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 305572 . This is a "PARTNER HMO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: STM040053 . This is a "MEDICAL COMP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1140267 . This is a "CARE PARTNER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4039765 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 507424406 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: E31401 . This is a "MERCY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 55772 . This is a "HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: PC23505 . This is a "CIGNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: STL040029 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 26810 . This is a "BLUE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 26810 . This is a "BLUE CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 889041 . This is a "COMMUNITY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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