1356414155 NPI number — REGIONAL SERVICES

Table of content: MR. SERGIO D HERNANDEZ LCPC (NPI 1720596950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356414155 NPI number — REGIONAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGIONAL SERVICES
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:
ROBERT D. BAZLEY, M.D.
Provider Other Organization Name Type Code:
3
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:
1356414155
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4046
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65808-4046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-269-7834
Provider Business Mailing Address Fax Number:
417-269-7567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 N LINCOLN AVE
Provider Second Line Business Practice Location Address:
#D
Provider Business Practice Location Address City Name:
MONETT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65708-1641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-236-2475
Provider Business Practice Location Address Fax Number:
417-354-1458
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
417-269-6262

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 506300706 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201481 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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