1235251018 NPI number — ALEXANDER T. KALK, MD, LLC

Table of content: (NPI 1235251018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235251018 NPI number — ALEXANDER T. KALK, MD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALEXANDER T. KALK, MD, LLC
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:
1235251018
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 372045
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:
63137-7045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-567-6565
Provider Business Mailing Address Fax Number:
314-567-6569

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11605 STUDT AVE STE 112
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:
63141-7052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-567-6565
Provider Business Practice Location Address Fax Number:
314-567-6569
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KALK
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
PROVIDER - OWNER
Authorized Official Telephone Number:
314-567-6565

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 193813 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: H75353 . This is a "MERCY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 0106708 . This is a "UHC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 671155 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 225770 . This is a "GROUP HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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