1073554085 NPI number — JOSEPH L SPALDING DO

Table of content: JOSEPH L SPALDING DO (NPI 1073554085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073554085 NPI number — JOSEPH L SPALDING DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPALDING
Provider First Name:
JOSEPH
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1073554085
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6500 HOSPITAL DR
Provider Second Line Business Mailing Address:
P O BOX 1239
Provider Business Mailing Address City Name:
HANNIBAL
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63401-6890
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-629-3370
Provider Business Mailing Address Fax Number:
573-406-5750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3145 HIGHWAY 61 STE A
Provider Second Line Business Practice Location Address:
MENTAL HEALTH
Provider Business Practice Location Address City Name:
HANNIBAL
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63401-6588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-629-3370
Provider Business Practice Location Address Fax Number:
573-406-5750
Provider Enumeration Date:
06/09/2006

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: 2084P0800X , with the licence number:  2000146152 , 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: CU0751 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: H62325 . This is a "MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2114411 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 245852702 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 166315 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 505995001 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 260051270 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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