1568531150 NPI number — JANE G GRADY PH.D.

Table of content: JANE G GRADY PH.D. (NPI 1568531150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568531150 NPI number — JANE G GRADY PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRADY
Provider First Name:
JANE
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1568531150
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 S MERAMEC AVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
ST. LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63105-3514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-863-6444
Provider Business Mailing Address Fax Number:
314-863-6324

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 S MERAMEC AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
ST. LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63105-3514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-863-6444
Provider Business Practice Location Address Fax Number:
314-863-6324
Provider Enumeration Date:
11/07/2006

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: 103TC0700X , with the licence number:  PY01445 , 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: 27968 . This is a "BLUE CROSS BLUE SHIELD MO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 148904 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 015694000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6115301 . This is a "UNITED HEALTHCARE UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 95286 . This is a "EXCLUSIVE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000596105 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 179630 . This is a "VALUEOPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 680010443 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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