1568543155 NPI number — MRS. SHERI L STOFER PA-C

Table of content: MRS. SHERI L STOFER PA-C (NPI 1568543155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568543155 NPI number — MRS. SHERI L STOFER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOFER
Provider First Name:
SHERI
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1568543155
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1905 W 19TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAIN GROVE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65711-1287
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-926-1770
Provider Business Mailing Address Fax Number:
417-926-1785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1905 W 19TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN GROVE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65711-1287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-926-1770
Provider Business Practice Location Address Fax Number:
417-926-1785
Provider Enumeration Date:
10/18/2006

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: 207RE0101X , with the licence number:  2003004256 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 2003004256 , 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: 26D2006074 . This is a "CLIA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: MA2517 . This is a "MEDICARE (GROUP)" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1285957001 . This is a "MEDICAID (GROUP)" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 26-8535 . This is a "MEDICARE - RH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 597780303 . This is a "MEDICAID - RH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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