1700973351 NPI number — DR. JAMES M SIMMERING MD

Table of content: DR. JAMES M SIMMERING MD (NPI 1700973351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700973351 NPI number — DR. JAMES M SIMMERING MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMMERING
Provider First Name:
JAMES
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1700973351
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6854 PARKER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORISSANT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63033-5313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-286-6988
Provider Business Mailing Address Fax Number:
314-868-2561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6812 STATE ROUTE 162
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
MARYVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62062-8553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-288-1122
Provider Business Practice Location Address Fax Number:
618-288-1144
Provider Enumeration Date:
10/06/2006

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: 207R00000X , with the licence number:  036067473 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 036067473 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08232205 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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