1174798938 NPI number — MULTI-SPECIALTY MENTAL HEALTH SERVICES, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174798938 NPI number — MULTI-SPECIALTY MENTAL HEALTH SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MULTI-SPECIALTY MENTAL HEALTH SERVICES, 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:
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:
1174798938
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1224 FERN RIDGE PKWY
Provider Second Line Business Mailing Address:
SUITE 305
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63141-4404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-205-8432
Provider Business Mailing Address Fax Number:
314-469-4507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1224 FERN RIDGE PKWY
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141-4404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-205-8432
Provider Business Practice Location Address Fax Number:
314-469-4507
Provider Enumeration Date:
04/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KABIR
Authorized Official First Name:
NAFISA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
314-205-8432

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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