1801133178 NPI number — APEX CLINICAL DIAGNOSTICS SERVICES

Table of content: CASSITY JAMIE RUSH GARDNER (NPI 1720822786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801133178 NPI number — APEX CLINICAL DIAGNOSTICS SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APEX CLINICAL DIAGNOSTICS SERVICES
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:
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:
1801133178
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12128 GRAVOIS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63127-1802
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:
12128 GRAVOIS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63127-1802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-503-3203
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HAIDER
Authorized Official First Name:
SYED
Authorized Official Middle Name:
TAKIR
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
314-503-3203

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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