1366692303 NPI number — PAUL M. PACKMAN INC.

Table of content: (NPI 1366692303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366692303 NPI number — PAUL M. PACKMAN INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAUL M. PACKMAN INC.
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:
1366692303
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8301 MARYLAND AVE
Provider Second Line Business Mailing Address:
SUITE 320
Provider Business Mailing Address City Name:
ST. LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-727-1666
Provider Business Mailing Address Fax Number:
314-727-5488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8301 MARYLAND AVE.
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
ST. LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-727-1666
Provider Business Practice Location Address Fax Number:
314-727-5488
Provider Enumeration Date:
09/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PACKMAN
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
314-727-1666

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  29193 , 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: 200743300 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 826262307 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 000005191 . This is a "MO MEDICARE SERVICES" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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