1912986506 NPI number — DR. WILLIAM CHRIS KOSTMAN M.D.

Table of content: DR. WILLIAM CHRIS KOSTMAN M.D. (NPI 1912986506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912986506 NPI number — DR. WILLIAM CHRIS KOSTMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOSTMAN
Provider First Name:
WILLIAM
Provider Middle Name:
CHRIS
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:
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:
1912986506
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10448 OLD OLIVE STREET RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CREVE COEUR
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63141-5967
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-966-8887
Provider Business Mailing Address Fax Number:
314-966-3869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10448 OLD OLIVE ST RD
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
CREVE COEUR
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-597-8887
Provider Business Practice Location Address Fax Number:
314-447-9559
Provider Enumeration Date:
01/11/2006

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: 207X00000X , with the licence number:  113686 , 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: 0900444 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: G59783 . This is a "MERCY #80" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 009219 . This is a "EXCLUSIVE CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 113052 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 55165 . This is a "GHP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5596509 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 335518 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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