1598737819 NPI number — AUBRA A HOUCHIN DO

Table of content: AUBRA A HOUCHIN DO (NPI 1598737819)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598737819 NPI number — AUBRA A HOUCHIN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOUCHIN
Provider First Name:
AUBRA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1598737819
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 BRANTLEIGH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CHARLES
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63301-4117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-947-4892
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
408 JUNGERMANN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63376-2799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-449-5757
Provider Business Practice Location Address Fax Number:
636-449-5750
Provider Enumeration Date:
02/02/2006

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: 207Q00000X , with the licence number:  R5C54 , 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: 40514 . This is a "HEALTHCARE USA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 0100268 . This is a "MEDICARE COMPLETE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 9458 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: PC10213 . This is a "CIGNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 104866 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4078508 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: A10766 . This is a "MERCY HEALTH PLANS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 242530400 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 431482544 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 100513 . This is a "BLUECROSS BLUESHIELD MO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 32396 . This is a "GROUP HEALTH PLAN (GHP)" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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