1750564647 NPI number — MOTOG INC.

Table of content: (NPI 1750564647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750564647 NPI number — MOTOG INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOTOG INC.
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:
6
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:
1750564647
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3394 MCKELVEY RD STE 115
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGETON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63044-2531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-866-7116
Provider Business Mailing Address Fax Number:
314-380-0872

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3394 MCKELVEY RD STE 115
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGETON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63044-2531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-866-7116
Provider Business Practice Location Address Fax Number:
314-380-0872
Provider Enumeration Date:
12/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GUTIERREZ
Authorized Official First Name:
ERNESTO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
314-866-7116

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35000 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 2002008231 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00001383 . This is a "NHC HEALTH BENEFITS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 617V4439 . This is a "CMR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 100380 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 100529 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2161557 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: D04076 . This is a "EXCLUSIVE CHOICCE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2107378-003 . This is a "CIGNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: CO1315 . This is a "MEDICARE RR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 0400423 . This is a "UHC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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