1922127786 NPI number — MRS. ANDREA JOERDING MAY M.S.O.T. OTR L

Table of content: MRS. ANDREA JOERDING MAY M.S.O.T. OTR L (NPI 1922127786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922127786 NPI number — MRS. ANDREA JOERDING MAY M.S.O.T. OTR L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAY
Provider First Name:
ANDREA
Provider Middle Name:
JOERDING
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.O.T. OTR L
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:
1922127786
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 339
Provider Second Line Business Mailing Address:
606 W MAIN
Provider Business Mailing Address City Name:
STEELVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65565-0339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-205-9074
Provider Business Mailing Address Fax Number:
573-775-4941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
606 W MAIN
Provider Second Line Business Practice Location Address:
STEELVILLE REORGANIZED SCH DIST R 3
Provider Business Practice Location Address City Name:
STEELVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65565-0339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-205-9074
Provider Business Practice Location Address Fax Number:
573-775-4941
Provider Enumeration Date:
03/29/2007

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: 225X00000X , with the licence number:  2003002559 , 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: 477544001 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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