1386883940 NPI number — BRIAN M. FORBES, D. C.

Table of content: (NPI 1386883940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386883940 NPI number — BRIAN M. FORBES, D. C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIAN M. FORBES, D. C.
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:
1386883940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4700 NAMEOKI RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANITE CITY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62040-2524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-797-2225
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4700 NAMEOKI RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANITE CITY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62040-2524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-797-2225
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
FORBES
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
618-797-2225

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 204779 . This is a "MEDICARE ID - TYPE UNSPECIFIED" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 387890 . This is a "MEDICARE ID - TYPE UNSPECIFIED" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 6007286 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00217167 . This is a "PALMETTO GBA-RR MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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