1386627404 NPI number — DR. NEIL F REBBE MD PHD

Table of content: DR. NEIL F REBBE MD PHD (NPI 1386627404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386627404 NPI number — DR. NEIL F REBBE MD PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REBBE
Provider First Name:
NEIL
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD PHD
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:
1386627404
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12255 DEPAUL DRIVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
BRIDGETON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-344-6021
Provider Business Mailing Address Fax Number:
314-344-6131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9553 LACKLAND RD
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63114-3640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-429-7733
Provider Business Practice Location Address Fax Number:
314-429-3194
Provider Enumeration Date:
11/22/2005

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: 208000000X , with the licence number:  110460 , 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: 205278419 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 270012989 . This is a "TAX ID ARS PEDIATRICS LLC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 416385 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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