1275687097 NPI number — B. J. PRICE, INC

Table of content: (NPI 1275687097)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275687097 NPI number — B. J. PRICE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
B. J. PRICE, 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:
1275687097
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 4 BOX 85A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DONIPHAN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63935-9307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-996-5413
Provider Business Mailing Address Fax Number:
573-996-7508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 N GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DONIPHAN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63935-1409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-996-5413
Provider Business Practice Location Address Fax Number:
573-996-7508
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PRICE
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
EMMETT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
573-996-5413

Provider Taxonomy Codes

  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320600000X , with the licence number: 1769-9716 , 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: 858900707 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com