1093994642 NPI number — CELSO F RODRIGUES MD PC

Table of content: (NPI 1093994642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093994642 NPI number — CELSO F RODRIGUES MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CELSO F RODRIGUES MD PC
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:
1093994642
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2674 FOX RUN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IMPERIAL
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63052-2024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-461-2711
Provider Business Mailing Address Fax Number:
636-461-0786

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2674 FOX RUN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IMPERIAL
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63052-2024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-461-2711
Provider Business Practice Location Address Fax Number:
636-461-0786
Provider Enumeration Date:
10/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUES
Authorized Official First Name:
CELSO
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
PRESIDENT/PHYSICIAN
Authorized Official Telephone Number:
636-461-2711

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  2001012442 , 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: DB4357 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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