1346224110 NPI number — JAMES E PARKER

Table of content: (NPI 1346224110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346224110 NPI number — JAMES E PARKER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES E PARKER
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:
1346224110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 938
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMDENTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65020-0938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-346-5556
Provider Business Mailing Address Fax Number:
573-346-5788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
802 N BUSINESS ROUTE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDENTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65020-2646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-346-5556
Provider Business Practice Location Address Fax Number:
573-346-5788
Provider Enumeration Date:
12/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PARKER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
EARL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
573-346-5556

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , 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: 57214 . This is a "57214" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 110845 . This is a "BCBS ITS UNIT" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 16952018 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 621781004 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 257852 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 621781020 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 82187 . This is a "NORTHWOOD NPN (ELDON STOR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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