1316025729 NPI number — DR. ADAM ALEXANDER BOGAART DC

Table of content: DR. ADAM ALEXANDER BOGAART DC (NPI 1316025729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316025729 NPI number — DR. ADAM ALEXANDER BOGAART DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOGAART
Provider First Name:
ADAM
Provider Middle Name:
ALEXANDER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1316025729
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1645 STATE ROAD Z
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
PEVELY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63070-2102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-479-6888
Provider Business Mailing Address Fax Number:
636-479-6088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1645 STATE ROAD Z
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PEVELY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63070-2102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-479-6888
Provider Business Practice Location Address Fax Number:
636-479-6088
Provider Enumeration Date:
11/02/2006

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: 111N00000X , with the licence number:  2004020948 , 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: 235360 . This is a "GHP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 342010901 . This is a "GREAT WEST HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 682626 . This is a "HEALTH LINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 143663 . This is a "UNITED" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2233510 . This is a "FIRST HEALTH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 342010901 . This is a "HUMANA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 235360 . This is a "CARPENTERS HEALTH AND WEL" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 342010901 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 342010901 . This is a "CIGNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 342010901 . This is a "HEALTH FIRST NETWORK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 342010901B0G . This is a "MERCY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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