1386971323 NPI number — AIDA TRIVIC N.P.

Table of content: AIDA TRIVIC N.P. (NPI 1386971323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386971323 NPI number — AIDA TRIVIC N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRIVIC
Provider First Name:
AIDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

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:
1386971323
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 BOONES LICK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CHARLES
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63301-2463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-916-8228
Provider Business Mailing Address Fax Number:
636-946-5774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
802 MEL CARNAHAN DR
Provider Second Line Business Practice Location Address:
APT 2015
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63050-2427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-543-2290
Provider Business Practice Location Address Fax Number:
636-789-2523
Provider Enumeration Date:
11/12/2009

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: 363LA2200X , with the licence number:  2005018080 , 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)





Copyright © 2007-2025 www.npivalidator.com