1619448453 NPI number — S THOMAS SEHY D P M L L C

Table of content: (NPI 1619448453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619448453 NPI number — S THOMAS SEHY D P M L L C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S THOMAS SEHY D P M L L C
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:
1619448453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10430 PAGE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63132-1228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-423-8811
Provider Business Mailing Address Fax Number:
314-423-8824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6651 CHIPPEWA ST STE 316
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63109-2532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-248-3668
Provider Business Practice Location Address Fax Number:
314-423-8824
Provider Enumeration Date:
12/05/2018

Additional Information

Authorized Official

Authorized Official Last Name:
MILLSTONE
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
TERESE
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
314-423-8811

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 305705824 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 346767581 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com