1760474662 NPI number — DR. JERRI L BIRSINGER O.D.

Table of content: DR. JERRI L BIRSINGER O.D. (NPI 1760474662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760474662 NPI number — DR. JERRI L BIRSINGER O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIRSINGER
Provider First Name:
JERRI
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

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:
1760474662
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1781 JEFFCO BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARNOLD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63010-2713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-200-5008
Provider Business Mailing Address Fax Number:
636-333-3093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1781 JEFFCO BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARNOLD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63010-2713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-200-5008
Provider Business Practice Location Address Fax Number:
636-333-3093
Provider Enumeration Date:
08/17/2005

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: 152WC0802X , with the licence number:  T03357 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WP0200X , with the licence number: T03357 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: T03357 , 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: BLC38016 . This is a "BLUE CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 410053835 . This is a "PALMETTO GBA RAILROAD MED" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 108559 . This is a "BC/BS ALLIANCE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 342121 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 60054 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 114488 . This is a "BLUE CROSS/ BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 22-02004 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 401501 . This is a "GROUP HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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