1457366270 NPI number — OPEN IMAGING PARTNERS

Table of content: (NPI 1457366270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457366270 NPI number — OPEN IMAGING PARTNERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPEN IMAGING PARTNERS
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:
1457366270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 796017
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-548-4779
Provider Business Mailing Address Fax Number:
314-548-4748

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 N NEW BALLAS RD
Provider Second Line Business Practice Location Address:
STE 20
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:
314-567-1818
Provider Business Practice Location Address Fax Number:
314-567-3359
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOODHOPE
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
314-567-1818

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 506863109 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65276 . This is a "GHP - ST CHARLES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 193990 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 26632 . This is a "GHP - ST LOUIS" identifier . This identifiers is of the category "OTHER".




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