1891962072 NPI number — TED C. VARGAS, INC.

Table of content: (NPI 1891962072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891962072 NPI number — TED C. VARGAS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TED C. VARGAS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1891962072
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
319 N 1ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PACIFIC
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63069-1505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-271-3500
Provider Business Mailing Address Fax Number:
636-271-9955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
319 N 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PACIFIC
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63069-1505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-271-3500
Provider Business Practice Location Address Fax Number:
636-271-9955
Provider Enumeration Date:
05/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
VARGAS
Authorized Official First Name:
TEODORO
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
636-271-3500

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  34914 , 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: 200864908 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100922001 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5523 . This is a "GROUP HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 101254 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: K92006 . This is a "EXCLUSIVE CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 18297 . This is a "ANTHEM" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2052 . This is a "HEALTHCARE USA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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