1255546990 NPI number — NEUROMAR

Table of content: (NPI 1255546990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255546990 NPI number — NEUROMAR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROMAR
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:
1255546990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
166 INDUSTRIAL DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FESTUS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-931-6090
Provider Business Mailing Address Fax Number:
636-933-9509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
166 INDUSTRIAL DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FESTUS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-931-6090
Provider Business Practice Location Address Fax Number:
636-933-9509
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ZEVALLOS
Authorized Official First Name:
JULIA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
636-931-6090

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  2000160887 , 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)

  • Identifier: 504599309 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: DF9044 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com