1548368004 NPI number — BLESSING CORPORATE SERVICES INC

Table of content: (NPI 1548368004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548368004 NPI number — BLESSING CORPORATE SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLESSING CORPORATE SERVICES 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:
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:
1548368004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6996 COUNTY ROAD 326
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMYRA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63461-3119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-769-3710
Provider Business Mailing Address Fax Number:
573-769-3753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6996 COUNTY ROAD 326
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMYRA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63461-3119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-769-3710
Provider Business Practice Location Address Fax Number:
573-769-3753
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
TIM
Authorized Official Middle Name:
Authorized Official Title or Position:
VP FINANCE / CAO
Authorized Official Telephone Number:
217-223-8400

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 151774 . This is a "BLUE SHIELD OF MO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 505757104 . This is a "MEDICAID PROVIDER NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 598783801 . This is a "MEDICAID PROVIDER NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: DA9532 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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