1528041696 NPI number — LAURA C HORN PAC

Table of content: LAURA C HORN PAC (NPI 1528041696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528041696 NPI number — LAURA C HORN PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORN
Provider First Name:
LAURA
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
F

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:
1528041696
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 PIPER HILL DR
Provider Second Line Business Mailing Address:
SUITE 9
Provider Business Mailing Address City Name:
SAINT PETERS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63376-1690
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-441-3444
Provider Business Mailing Address Fax Number:
636-926-2858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 PIPER HILL DR
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
SAINT PETERS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63376-1690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-441-3444
Provider Business Practice Location Address Fax Number:
636-926-2858
Provider Enumeration Date:
11/22/2005

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: 363AS0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: 2002028066 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: P00657543 . This is a "RR MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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