1942396056 NPI number — SAAID KHOJASTEH MD & ASSOCIATES

Table of content: DR. GERALDINE LEE URSE D.O. (NPI 1285616722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942396056 NPI number — SAAID KHOJASTEH MD & ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAAID KHOJASTEH MD & ASSOCIATES
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:
1942396056
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:
255 SPENCER RD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
SAINT PETERS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63376-2494
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-939-2550
Provider Business Mailing Address Fax Number:
636-939-2551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 SPENCER RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SAINT PETERS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63376-2494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-939-2550
Provider Business Practice Location Address Fax Number:
636-939-2551
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KHOJASTEH
Authorized Official First Name:
SAAID
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
636-939-2550

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  36844 , 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)





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