1275590432 NPI number — SJMDHS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275590432 NPI number — SJMDHS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SJMDHS, 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:
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:
1275590432
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13190 S OUTER 40
Provider Second Line Business Mailing Address:
LEVEL I
Provider Business Mailing Address City Name:
CHESTERFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63017-5917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-392-6380
Provider Business Mailing Address Fax Number:
314-392-6379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13190 S OUTER 40
Provider Second Line Business Practice Location Address:
LEVEL I
Provider Business Practice Location Address City Name:
CHESTERFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63017-5917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-392-6380
Provider Business Practice Location Address Fax Number:
314-392-6379
Provider Enumeration Date:
04/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VEILLON
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
BOARD MEMBER
Authorized Official Telephone Number:
713-277-2330

Provider Taxonomy Codes

  • Taxonomy code: 282E00000X , with the licence number:  498-0 , 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: 7572911 . This is a "AETNA PIN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 401054 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1385744 . This is a "AETNA PVN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 013805700 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 207853 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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