1275671588 NPI number — LEONARD HUGHES CO INC

Table of content: (NPI 1275671588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275671588 NPI number — LEONARD HUGHES CO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEONARD HUGHES CO INC
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:
1275671588
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8456 WATSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63119-5217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-961-1211
Provider Business Mailing Address Fax Number:
314-961-4053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8456 WATSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63119-5217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-961-1211
Provider Business Practice Location Address Fax Number:
314-961-4053
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BECKHAM
Authorized Official First Name:
MARSHA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
314-961-1211

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 320813801 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000009318 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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