1881979623 NPI number — MRS. MARIA LOUISE CUNNINGHAM LPT

Table of content: MRS. MARIA LOUISE CUNNINGHAM LPT (NPI 1881979623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881979623 NPI number — MRS. MARIA LOUISE CUNNINGHAM LPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUNNINGHAM
Provider First Name:
MARIA
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPT
Provider Gender Code:
F

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:
1881979623
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
916 TALON DR
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
O FALLON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62269-1848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-628-8211
Provider Business Mailing Address Fax Number:
618-628-0883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
916 TALON DR
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
O FALLON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62269-1848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-628-8211
Provider Business Practice Location Address Fax Number:
618-628-0883
Provider Enumeration Date:
10/12/2011

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: 2081P2900X , with the licence number:  070018731 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 900068033 . This is a "HNFS TRICARE NORTH REGION" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 900068033 . This is a "BCBS OF IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 900068033 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 900068033 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 900068033 . This is a "CIGNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 900068033 . This is a "GHP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 146703 . This is a "MEDICARE PART A" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 900068033 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com