1437253754 NPI number — CYBER DIAGNOSTIC MEDICINE LLC

Table of content: (NPI 1437253754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437253754 NPI number — CYBER DIAGNOSTIC MEDICINE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CYBER DIAGNOSTIC MEDICINE LLC
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:
6
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:
1437253754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11901 W FLORISSANT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORISSANT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63033-6778
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-839-9901
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11901 W FLORISSANT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORISSANT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63033-6778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-839-9901
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAIDER
Authorized Official First Name:
SYED
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
314-839-9901

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X , with the licence number:  NA , 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: 141322400 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1952654 . This is a "FIRST HEALTH HAMPTON" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 98923 . This is a "GROUP HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: M0754 . This is a "ONE CALL MEDICAL FLORISSA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 37636 . This is a "HCUSA HAMPTON" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 466492 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2632204 . This is a "AETNA HMO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 49881 . This is a "HCUSA FLORISSANT" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 717265102 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00322519 . This is a "MEDICARE RR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 0334 . This is a "MERCY CAREPLUS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: M0753 . This is a "ONE CALL MEDICAL HAMPTON" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1601446 . This is a "UHC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 193985 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5495635 . This is a "CCN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2233063 . This is a "FIRST HEALTH FLORISSANT" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4446827 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: A149477 . This is a "MULTIPLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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