1215202510 NPI number — DR. JOSEPH JASON GRASSINO DMS, PA-C

Table of content: DR. JOSEPH JASON GRASSINO DMS, PA-C (NPI 1215202510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215202510 NPI number — DR. JOSEPH JASON GRASSINO DMS, PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRASSINO
Provider First Name:
JOSEPH
Provider Middle Name:
JASON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMS, PA-C
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:
1215202510
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
58 VERDANT VIEW MANOR CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WENTZVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63385-4995
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-608-9438
Provider Business Mailing Address Fax Number:
314-881-4269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14561 N OUTER 40 RD STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTERFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63017-5703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-881-4280
Provider Business Practice Location Address Fax Number:
314-881-4296
Provider Enumeration Date:
03/20/2012

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: 363AM0700X , with the licence number:  2012008459 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: 2012008459 , 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)





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