1780621789 NPI number — VOYAGER GROUP, INC

Table of content: (NPI 1780621789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780621789 NPI number — VOYAGER GROUP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VOYAGER GROUP, 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:
1780621789
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4800 MEXICO RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
SAINT PETERS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63376-1666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-936-0400
Provider Business Mailing Address Fax Number:
636-936-2252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 MEXICO RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SAINT PETERS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63376-1666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-936-0400
Provider Business Practice Location Address Fax Number:
636-936-2252
Provider Enumeration Date:
05/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VELLINGA
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
636-936-0400

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  R5P16 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: R5P16 , 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: 050055140 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 491711815 . This is a "1ST HEALTH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2000224 . This is a "UHC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 249776 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 35554 . This is a "GHP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 197791 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 35554 . This is a "CMR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 63868010001 . This is a "CIGNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: F04439 . This is a "MERCY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 072246 . This is a "FMH/ EXCLUSIVE CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 246938112 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 197791 . This is a "BLUE CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5339096 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2000224 . This is a "PHP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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