1558445593 NPI number — CITY OF KIRKWOOD

Table of content: (NPI 1558445593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558445593 NPI number — CITY OF KIRKWOOD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF KIRKWOOD
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:
1558445593
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 220579
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KIRKWOOD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63122-0579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-538-8278
Provider Business Mailing Address Fax Number:
580-628-2273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
139 S KIRKWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKWOOD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63122-4303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-538-8278
Provider Business Practice Location Address Fax Number:
580-628-2273
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNTANT
Authorized Official Telephone Number:
800-538-8278

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  189111 , 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: P00052509 . This is a "RRMC PROVIDER NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 179258 . This is a "BC/BS PROVIDER NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com