1407844715 NPI number — JOHN H BECHTEL MD

Table of content: JOHN H BECHTEL MD (NPI 1407844715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407844715 NPI number — JOHN H BECHTEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BECHTEL
Provider First Name:
JOHN
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1407844715
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1241 W STADIUM BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEFFERSON CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65109-6023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-635-2282
Provider Business Mailing Address Fax Number:
573-635-2536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2809 DENNY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASCAGOULA
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39581-5301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-809-5251
Provider Business Practice Location Address Fax Number:
228-809-5255
Provider Enumeration Date:
10/11/2005

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: 2085R0001X , with the licence number:  2003027615 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: 26077 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 208999201 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 214340 . This is a "GHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33739011 . This is a "BCBS OF KC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3600603 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: H99009 . This is a "MERCY HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 189992 . This is a "BCBS OF MO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5132415 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 65201A005 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 661744 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com