1124014329 NPI number — FERDINAND J. MUELLER, LTD.

Table of content: (NPI 1124014329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124014329 NPI number — FERDINAND J. MUELLER, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FERDINAND J. MUELLER, LTD.
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:
1124014329
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
180 S 3RD ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
BELLEVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62220-1952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-233-0017
Provider Business Mailing Address Fax Number:
618-233-0251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 S 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BELLEVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62220-1952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-233-0017
Provider Business Practice Location Address Fax Number:
618-233-0251
Provider Enumeration Date:
09/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MUELLER
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
V.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
618-233-0017

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 130304 . This is a "BLUE ADVANTAGE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2444V9469 . This is a "GROUP HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 231290 . This is a "MEDICARE GROUP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 105592 . This is a "BLUE ADVANTAGE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 111843 . This is a "BLUE ADVANTAGE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 8215125 . This is a "BC/BS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 105469 . This is a "BLUE ADVANTAGE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2113V9469 . This is a "GROUP HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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