1811981707 NPI number — DR. JAY P MULLIGAN JR. DC

Table of content: DR. JAY P MULLIGAN JR. DC (NPI 1811981707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811981707 NPI number — DR. JAY P MULLIGAN JR. DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULLIGAN
Provider First Name:
JAY
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
DC
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:
1811981707
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11872 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:
63127-1800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-849-3040
Provider Business Mailing Address Fax Number:
314-849-7279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11872 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:
63127-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-849-3040
Provider Business Practice Location Address Fax Number:
314-849-7279
Provider Enumeration Date:
09/07/2005

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: 111N00000X , with the licence number:  005086 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 1550 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 5684 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 250010 . This is a "ASHN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5086 . This is a "ALL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1329576 . This is a "PRINCIPAL HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3082849 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5224 . This is a "BCBS ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3082849 . This is a "AMERICAN SPECIALTY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 250888 . This is a "ACN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 000000010306 . This is a "ESSENCE HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 177379 . This is a "HEALTHLINK PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 177379 . This is a "HEALTHLINK HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 140968 . This is a "GHP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4218073 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4218073 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 177379 . This is a "CARPENTERS HL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4400465 . This is a "MEDICARE COMPLETE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5224 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 350057134 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4400465 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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