1255387494 NPI number — DR. TAMMAM NMI AL-JOUNDI MD

Table of content: DR. TAMMAM NMI AL-JOUNDI MD (NPI 1255387494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255387494 NPI number — DR. TAMMAM NMI AL-JOUNDI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AL-JOUNDI
Provider First Name:
TAMMAM
Provider Middle Name:
NMI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1255387494
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10012 KENNERLY RD STE 301
Provider Second Line Business Mailing Address:
301
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63128-2197
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-729-0088
Provider Business Mailing Address Fax Number:
314-729-3963

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10012 KENNERLY ROAD
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
ST LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-729-0088
Provider Business Practice Location Address Fax Number:
314-729-3963
Provider Enumeration Date:
05/26/2006

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: 207RC0000X , with the licence number:  111666 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: 036103650 , 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: 12557 . This is a "ESSENCE HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 129698 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2358779 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 04232002 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1840134 . This is a "FIRST HEALTH NETWORK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 6325641 . This is a "CIGNA HMO PPO OPEN ACCESS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 127029 . This is a "CARE PARTNERS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 208626523 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 441679 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 21263 . This is a "EXCLUSIVE CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2500250 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 6325641001 . This is a "CIGNA PAL REFERRAL" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: G44678 . This is a "MERCY HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 37625 . This is a "HEALTHCARE USA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 61903 . This is a "GROUP HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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