1346293297 NPI number — DR. ANN LESLEY MCLAREN MD

Table of content: DR. ANN LESLEY MCLAREN MD (NPI 1346293297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346293297 NPI number — DR. ANN LESLEY MCLAREN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCLAREN
Provider First Name:
ANN
Provider Middle Name:
LESLEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1346293297
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
531 PEBBLE BROOK LN
Provider Second Line Business Mailing Address:
HMAI
Provider Business Mailing Address City Name:
BELLEVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62221-7609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-779-5508
Provider Business Mailing Address Fax Number:
618-206-8588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6125 CLAYTON AVE
Provider Second Line Business Practice Location Address:
STE 222
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63139-3265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-768-3685
Provider Business Practice Location Address Fax Number:
314-768-3940
Provider Enumeration Date:
05/19/2006

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:  R9664 , 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: 201413028 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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