1114068988 NPI number — DR. VEDA E. LEWIS-SIMMONS DPM MHA LLC

Table of content: (NPI 1114068988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114068988 NPI number — DR. VEDA E. LEWIS-SIMMONS DPM MHA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. VEDA E. LEWIS-SIMMONS DPM MHA LLC
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:
1114068988
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
O FALLON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63366-0012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-323-0669
Provider Business Mailing Address Fax Number:
314-524-4101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10421 W FLORISSANT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63136-2342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-524-4100
Provider Business Practice Location Address Fax Number:
314-524-4101
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS SIMMONS
Authorized Official First Name:
VEDA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
314-323-0669

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  772 , 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: 08232038 . This is a "ILLINOIS BLUE CROSS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 110194 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2708700 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 50302 . This is a "HEALTHCARE USA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5316557 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 32420 . This is a "GROUP HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 333503 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 205061 . This is a "ILLINOIS MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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