1518111368 NPI number — NETCARE HEALTH PROFESSIONALS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518111368 NPI number — NETCARE HEALTH PROFESSIONALS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NETCARE HEALTH PROFESSIONALS, INC.
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:
1518111368
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10805 SUNSET OFFICE DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63127-1017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-995-6262
Provider Business Mailing Address Fax Number:
314-995-6260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10805 SUNSET OFFICE DR
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63127-1017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-995-6262
Provider Business Practice Location Address Fax Number:
314-995-6260
Provider Enumeration Date:
11/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HAILEMARIAM
Authorized Official First Name:
HABTOM
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
314-995-6262

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X , with the licence number:  MD201504 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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