1336674258 NPI number — SMARTAGE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336674258 NPI number — SMARTAGE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMARTAGE 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:
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:
1336674258
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16216 BAXTER ROAD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CHESTERFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-449-4700
Provider Business Mailing Address Fax Number:
636-449-2595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16216 BAXTER RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CHESTERFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63017-4770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-449-4700
Provider Business Practice Location Address Fax Number:
636-449-2595
Provider Enumeration Date:
04/28/2017

Additional Information

Authorized Official

Authorized Official Last Name:
STITH
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/OPERATOR
Authorized Official Telephone Number:
636-449-4700

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  101659 , 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)





Copyright © 2007-2025 www.npivalidator.com