1932374592 NPI number — MELVIN A. TANN, ACSW, LCSW, LLC

Table of content: (NPI 1932374592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932374592 NPI number — MELVIN A. TANN, ACSW, LCSW, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MELVIN A. TANN, ACSW, LCSW, LLC
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:
1932374592
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7750 CLAYTON RD STE 300
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:
63117-1341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-644-4600
Provider Business Mailing Address Fax Number:
314-644-3274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7750 CLAYTON RD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63117-1341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-644-4600
Provider Business Practice Location Address Fax Number:
314-644-3274
Provider Enumeration Date:
04/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TANN
Authorized Official First Name:
MELVIN
Authorized Official Middle Name:
AVON
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
314-644-4600

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW003913 , 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: 117385 . This is a "ANTHEM BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5791112 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 496893306 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5628917 . This is a "CIGNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 120062 . This is a "VALUEOPTIONS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: R22291 . This is a "MERCY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 111089000 . This is a "COMMUNITY CAREPLUS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 196019 . This is a "MHNET" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 19323745924 . This is a "MEDICARE ORGANIZATION" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 270157 . This is a "PRINCIPAL LIFE INS. CO." identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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