1811930092 NPI number — DR. ISAM S HAWATMEH M D

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811930092 NPI number — DR. ISAM S HAWATMEH M D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAWATMEH
Provider First Name:
ISAM
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
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:
HAWATMEH
Provider Other First Name:
SAM
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M D
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1811930092
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12345 W BEND DR STE 304
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:
63128-2256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-722-2500
Provider Business Mailing Address Fax Number:
314-722-2556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12345 W BEND DR STE 304
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:
63128-2256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-722-2500
Provider Business Practice Location Address Fax Number:
314-645-8244
Provider Enumeration Date:
06/14/2006

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: 207R00000X , with the licence number:  R7D78 , 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: 1110163355 . This is a "RRMCR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 20315 . This is a "HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 26810 . This is a "BLUE CROSS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1140267 . This is a "CARE PARTNER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: PC23505 . This is a "CIGNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 125694 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 178V178 . This is a "GHP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 305572 . This is a "PARTNER HMO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 889041 . This is a "COMMUNITY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: STL040029 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 178V178 . This is a "CMR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: STM040053 . This is a "MED COMP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1125337 . This is a "FIRST HORIZON" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1811930092 . This is a "ANY INSURANCES" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 202132114 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26810 . This is a "BLUE CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 431540492 . This is a "COMMERICAL" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com