1023092764 NPI number — CITY OF RICHMOND HEIGHTS

Table of content: (NPI 1023092764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023092764 NPI number — CITY OF RICHMOND HEIGHTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF RICHMOND HEIGHTS
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:
1023092764
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 795089
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63179-0795
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7447 DALE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND HEIGHTS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63117-2209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-645-8800
Provider Business Practice Location Address Fax Number:
314-655-3584
Provider Enumeration Date:
12/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DREXLER
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
314-655-3580

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  189324 , 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: P00154347 . This is a "RAILROAD MEDICARE PROV. #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 801653908 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 119462 . This is a "BCBS PROVIDER NO." identifier . This identifiers is of the category "OTHER".
  • Identifier: 8182042 . This is a "UNITED HEALTHCARE PROV #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12573 . This is a "HEALTHCAREUSA PROVIDER #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33671 . This is a "GHP PROVIDER NO." identifier . This identifiers is of the category "OTHER".




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