1922185487 NPI number — PHILIP W. MEYER MD PC

Table of content: (NPI 1922185487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922185487 NPI number — PHILIP W. MEYER MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHILIP W. MEYER MD PC
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:
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:
1922185487
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4905 S 107TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68127-1965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-393-9459
Provider Business Mailing Address Fax Number:
402-397-9895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 RIDGE ST
Provider Second Line Business Practice Location Address:
SUITE 314
Provider Business Practice Location Address City Name:
COUNCIL BLUFFS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51503-4643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-322-0253
Provider Business Practice Location Address Fax Number:
712-322-5273
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MEYER
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
712-322-0253

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  20597 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 14027 . This is a "BCBS IA PROVIDER #" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0140277 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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