1356647077 NPI number — MR. VICTOR ARTHUR MARCHLEWSKI III PLPC

Table of content: MR. VICTOR ARTHUR MARCHLEWSKI III PLPC (NPI 1356647077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356647077 NPI number — MR. VICTOR ARTHUR MARCHLEWSKI III PLPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARCHLEWSKI
Provider First Name:
VICTOR
Provider Middle Name:
ARTHUR
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
PLPC
Provider Gender Code:
M

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:
1356647077
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2850 W CLAY ST
Provider Second Line Business Mailing Address:
SUITE 255
Provider Business Mailing Address City Name:
SAINT CHARLES
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63301-2573
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
636-925-3159

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2850 W CLAY ST
Provider Second Line Business Practice Location Address:
SUITE 255
Provider Business Practice Location Address City Name:
SAINT CHARLES
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63301-2573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-627-7974
Provider Business Practice Location Address Fax Number:
636-925-3159
Provider Enumeration Date:
01/27/2011

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: 101YP2500X , with the licence number:  2011001824 , 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)





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