1043272693 NPI number — REGINA Y CHIU M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043272693 NPI number — REGINA Y CHIU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHIU
Provider First Name:
REGINA
Provider Middle Name:
Y
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1043272693
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
THREE SAINT ELIZABETH BLVD STE 2800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
O FALLON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62269-1282
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-233-6044
Provider Business Mailing Address Fax Number:
833-973-4218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
THREE SAINT ELIZABETH BLVD STE 2800
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
O FALLON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62269-1282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-233-6044
Provider Business Practice Location Address Fax Number:
833-973-4218
Provider Enumeration Date:
04/06/2006

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: 207RC0000X , with the licence number:  036118748 , 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: 139035 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00412776 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 325776 . This is a "GHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 325776 . This is a "CMR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 868703 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 220367 . This is a "BCBS MO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2270597 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2501939 . This is a "SECURE HORIZONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 577190 . This is a "SPARTA PTAN MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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