1336114800 NPI number — DR. RACHELLE L GORRELL D.O.

Table of content: DR. RACHELLE L GORRELL D.O. (NPI 1336114800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336114800 NPI number — DR. RACHELLE L GORRELL D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GORRELL
Provider First Name:
RACHELLE
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

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:
1336114800
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 W 10TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROLLA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65401-2905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-364-9000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 N JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT JAMES
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-265-8840
Provider Business Practice Location Address Fax Number:
573-202-2474
Provider Enumeration Date:
02/20/2006

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: 207Q00000X , with the licence number:  2001007763 , 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: 002013368 . This is a "FFS MEDICARE/WPS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 263904 . This is a "RURAL HEALTH MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 431908560 . This is a "TRIWEST" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 464413 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 245323704 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 431908560 . This is a "PHCS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 596841403 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0101983 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 080174605 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 144176 . This is a "BLUE SHIELD OF MO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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