1104157387 NPI number — GOING PUBLIC MINISTRIES

Table of content: (NPI 1104157387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104157387 NPI number — GOING PUBLIC MINISTRIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOING PUBLIC MINISTRIES
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:
6
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:
1104157387
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 LEMAY FERRY RD
Provider Second Line Business Mailing Address:
SUITE 132
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63125-1501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-637-7443
Provider Business Mailing Address Fax Number:
866-695-0277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4171 CRESCENT DR
Provider Second Line Business Practice Location Address:
SUITE 101A
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63129-3645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-629-7191
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KURTH
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
314-629-7191

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1194975185 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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