1811007289 NPI number — STEVEN A. HARVEY M.D.

Table of content: BRANDY MOORE APRN (NPI 1376264762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811007289 NPI number — STEVEN A. HARVEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARVEY
Provider First Name:
STEVEN
Provider Middle Name:
A.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1811007289
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11477 OLDE CABIN RD
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63141-7130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-997-5208
Provider Business Mailing Address Fax Number:
314-567-5368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11477 OLDE CABIN RD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141-7130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-997-5208
Provider Business Practice Location Address Fax Number:
314-997-5269
Provider Enumeration Date:
08/30/2006

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: 2084P0800X , with the licence number:  101008 , 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: 1534594 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 3207079 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 208304832 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106676 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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