1326126525 NPI number — IDXPERT, P.C.

Table of content: (NPI 1326126525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326126525 NPI number — IDXPERT, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IDXPERT, P.C.
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:
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:
1326126525
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB BELLAS LOMAS
Provider Second Line Business Mailing Address:
#907 CALLE CRUZ
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00682
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-729-1350
Provider Business Mailing Address Fax Number:
314-222-0614

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10004 KENNERLY RD
Provider Second Line Business Practice Location Address:
SUITE 259B
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63128-2141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-729-1350
Provider Business Practice Location Address Fax Number:
314-222-0614
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CRUZ
Authorized Official First Name:
ORLANDO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
314-729-1350

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2056665 . This is a "AETNA HMO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 9200025 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1555912 . This is a "CIGNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 290274 . This is a "GHP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2220 . This is a "HEALTHCARE USA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 110831 . This is a "BLUE CROSS-BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 11563 . This is a "ESSENCE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 290274 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5056433805 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5859116 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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