1275543969 NPI number — DR. RAYMOND J MEYER M.D.

Table of content: DR. RAYMOND J MEYER M.D. (NPI 1275543969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275543969 NPI number — DR. RAYMOND J MEYER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEYER
Provider First Name:
RAYMOND
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1275543969
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
725 SCHOOL ST STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRIS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60450-1207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-705-1405
Provider Business Mailing Address Fax Number:
815-941-4363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1051 W US ROUTE 6
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MORRIS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60450-3349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-942-4875
Provider Business Practice Location Address Fax Number:
815-942-5046
Provider Enumeration Date:
08/08/2006

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: 207X00000X , with the licence number:  036091735 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 024685 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: CL7476 . This is a "RAILROAD MEDICARE GROUP #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0739010005 . This is a "MEDICARE NSC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 200029522 . This is a "RR MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 3200053 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036091735 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0739010001 . This is a "MEDICARE NSC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0739010008 . This is a "MEDICARE NSC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0739010006 . This is a "MEDICARE NSC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com