1841474889 NPI number — DR. PATRICIA CAROL COUGHLIN PHD

Table of content: DR. PATRICIA CAROL COUGHLIN PHD (NPI 1841474889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841474889 NPI number — DR. PATRICIA CAROL COUGHLIN PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COUGHLIN
Provider First Name:
PATRICIA
Provider Middle Name:
CAROL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COUGHLIN
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
CAROL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1841474889
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11349 CRAGWOLD 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:
63122-7010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-965-3466
Provider Business Mailing Address Fax Number:
314-835-0021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13610 BARRETT OFFICE DR.
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
ST LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-662-0557
Provider Business Practice Location Address Fax Number:
314-835-0021
Provider Enumeration Date:
12/27/2007

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: 101Y00000X , with the licence number:  SW000750 , 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)





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