1639174659 NPI number — JOHN D MCGARRY M.D.

Table of content: JOHN D MCGARRY M.D. (NPI 1639174659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639174659 NPI number — JOHN D MCGARRY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGARRY
Provider First Name:
JOHN
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCGARRY
Provider Other First Name:
JOHN
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1639174659
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 470
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRYSTAL CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63019-0470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-937-0005
Provider Business Mailing Address Fax Number:
636-933-9494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
168 INDUSTRIAL DR
Provider Second Line Business Practice Location Address:
MEDICAL VILLAGE ANNEX BUILDING
Provider Business Practice Location Address City Name:
FESTUS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63028-4133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-937-0005
Provider Business Practice Location Address Fax Number:
636-933-9494
Provider Enumeration Date:
06/16/2005

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: 2081P0004X , with the licence number:  35835 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 35835 , 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: 200427128 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0500010 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 130001044 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 3008 . This is a "BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 116562 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4311996 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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