1154418119 NPI number — HUGO A VILLARREAL M.D.

Table of content: HUGO A VILLARREAL M.D. (NPI 1154418119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154418119 NPI number — HUGO A VILLARREAL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VILLARREAL
Provider First Name:
HUGO
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1154418119
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13276 MANCHESTER RD
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:
63131-1706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-822-9733
Provider Business Mailing Address Fax Number:
314-822-9838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13276 MANCHESTER RD
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:
63131-1706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-822-9733
Provider Business Practice Location Address Fax Number:
314-822-9838
Provider Enumeration Date:
10/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  103770 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RG0100X , with the licence number: 036-086874 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 110214224 . This is a "RR MEDICARE MO AREA 99" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 132551 . This is a "BCBS MO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 04227854 . This is a "BCBS IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 41206V41207 . This is a "GHP (ALL PLANS)" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 431907959 . This is a "TRICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5173V22657 . This is a "HEALTH CARE USA" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 951940001 . This is a "MEDICARE99" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 288486 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: F83209 . This is a "MERCY (ALL PLANS)" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2909029 . This is a "UHC (ALL)" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5104133 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 100015334 . This is a "RR MEDICARE MO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 208254003 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 431907959 . This is a "GREAT WEST" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 100015333 . This is a "RR MEDICARE IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 95286 . This is a "EXCLUSIVE CHOICE (FMH)" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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