1124324140 NPI number — ADMINISTRATIVE SUPPORT SERVICES GROUP INC

Table of content: (NPI 1124324140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124324140 NPI number — ADMINISTRATIVE SUPPORT SERVICES GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADMINISTRATIVE SUPPORT SERVICES GROUP INC
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:
FLORISSANT MEDICAL
Provider Other Organization Name Type Code:
3
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:
1124324140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4579 LACLEDE AVE # 229
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63108-2103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-367-5622
Provider Business Mailing Address Fax Number:
314-367-3996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4585 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE A1
Provider Business Practice Location Address City Name:
FLORISSANT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63033-5858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-921-4860
Provider Business Practice Location Address Fax Number:
314-921-4878
Provider Enumeration Date:
02/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HELFERSTAY
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
314-367-5622

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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