1114104114 NPI number — RICK HUMMEL MD PC

Table of content: (NPI 1114104114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114104114 NPI number — RICK HUMMEL MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICK HUMMEL 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:
1114104114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11155 DUNN RD
Provider Second Line Business Mailing Address:
201N
Provider Business Mailing Address City Name:
ST LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-741-1400
Provider Business Mailing Address Fax Number:
314-741-0175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11155 DUNN RD
Provider Second Line Business Practice Location Address:
201N
Provider Business Practice Location Address City Name:
ST LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-741-1400
Provider Business Practice Location Address Fax Number:
314-741-0175
Provider Enumeration Date:
01/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HUMMEL
Authorized Official First Name:
RICK
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
314-741-1400

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  R3D69 , 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: CI5813 . This is a "RR MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 150936 . This is a "BC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 31886 . This is a "GHP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 202626305 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com