1437347234 NPI number — ANAT RESCHKE, PH.D., LLC

Table of content: (NPI 1437347234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437347234 NPI number — ANAT RESCHKE, PH.D., LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANAT RESCHKE, PH.D., 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:
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:
1437347234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10420 OLD OLIVE STREET RD.
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
ST LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-991-9700
Provider Business Mailing Address Fax Number:
314-991-7779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10420 OLD OLIVE STREET RD.
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
ST LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-991-9700
Provider Business Practice Location Address Fax Number:
314-991-7779
Provider Enumeration Date:
10/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RESCHKE
Authorized Official First Name:
ANAT
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
314-569-2525

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  2001024796 , 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: 149532 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 466844 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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