1336363431 NPI number — DRS SZEWCZYK & NEKOLA LLC

Table of content: (NPI 1336363431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336363431 NPI number — DRS SZEWCZYK & NEKOLA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS SZEWCZYK & NEKOLA LLC
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:
1336363431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4900 WEST MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62226-4725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-235-2400
Provider Business Mailing Address Fax Number:
618-235-0900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4900 WEST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62226-4725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-235-2400
Provider Business Practice Location Address Fax Number:
618-235-0900
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SZEWCZYK
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
618-235-2400

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  036092365 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00762 . This is a "PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 08215191 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: G55037 . This is a "UPIN NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: L59429 . This is a "PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: CB0524 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 036070355 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036031388 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036092365 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00761 . This is a "PIN" identifier . This identifiers is of the category "OTHER".




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