1679560015 NPI number — RICHARD O. FOLLWELL, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679560015 NPI number — RICHARD O. FOLLWELL, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD O. FOLLWELL, P.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:
1679560015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 MEDICAL DR
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
WENTZVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63385-3426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-332-6606
Provider Business Mailing Address Fax Number:
636-639-5048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 MEDICAL DR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
WENTZVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63385-3426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-332-6606
Provider Business Practice Location Address Fax Number:
636-639-5048
Provider Enumeration Date:
09/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LAPOINTE
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
636-332-6606

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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