1912995317 NPI number — DR. HARRY C EGGLESTON M.D.

Table of content: DR. HARRY C EGGLESTON M.D. (NPI 1912995317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912995317 NPI number — DR. HARRY C EGGLESTON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EGGLESTON
Provider First Name:
HARRY
Provider Middle Name:
C
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:
1912995317
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 790051
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:
63179-0051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-872-7744
Provider Business Mailing Address Fax Number:
314-810-5296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
633 EMERSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CREVE COEUR
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141-6739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-872-7744
Provider Business Practice Location Address Fax Number:
314-810-5296
Provider Enumeration Date:
10/10/2005

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: 207W00000X , with the licence number:  R4544 , 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: 45050 . This is a "GHP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: A10830 . This is a "GREATWEST HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 101139 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 0800077 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 17203 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4039678 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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