1689626475 NPI number — DAVID L MEERS PT

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 1689626475 NPI number — DAVID L MEERS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEERS
Provider First Name:
DAVID
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1689626475
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
607 DEWEY AVE NW
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49504-7335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-356-5000
Provider Business Mailing Address Fax Number:
616-356-5001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 FIRST EXECUTIVE AVE STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PETERS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63376-1655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-939-9540
Provider Business Practice Location Address Fax Number:
636-939-9886
Provider Enumeration Date:
05/17/2006

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: 225100000X , with the licence number:  100408 , 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: 11408293 . This is a "CAQH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 650023376 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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