1750335121 NPI number — FRED D BIGGS MD

Table of content: FRED D BIGGS MD (NPI 1750335121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750335121 NPI number — FRED D BIGGS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIGGS
Provider First Name:
FRED
Provider Middle Name:
D
Provider Name Prefix Text:
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:
1750335121
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 MERCY WAY STE 320-330
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOPLIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64804-4524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MERCY WAY STE 320-330
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64804-4524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-781-5387
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/20/2006

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:  R6024 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: R6024 , 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: 33202011 . This is a "BLUE SHIELD OF KC HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4596969 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33202011 . This is a "PHP FREEDOM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060068300 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4596969 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4596969 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1205853389 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 431092652 A003 . This is a "CHAMPUS TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33202011 . This is a "BLUE SHIELD OF KC PPO" identifier . This identifiers is of the category "OTHER".




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