1245212133 NPI number — JOSEPH E. PEHLMAN

Table of content: (NPI 1245212133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245212133 NPI number — JOSEPH E. PEHLMAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH E. PEHLMAN
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:
6
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:
1245212133
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 526
Provider Second Line Business Mailing Address:
1207 NORTH DOUGLASS STREET
Provider Business Mailing Address City Name:
MALDEN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63863-0526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-276-3884
Provider Business Mailing Address Fax Number:
573-276-3885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1207 N DOUGLASS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MALDEN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63863-1351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-276-3884
Provider Business Practice Location Address Fax Number:
573-276-3885
Provider Enumeration Date:
11/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PEHLMAN
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
573-276-3884

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 595057308 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com