1952432478 NPI number — CDE HEALTH CARE SERVICES

Table of content: (NPI 1952432478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952432478 NPI number — CDE HEALTH CARE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CDE HEALTH CARE SERVICES
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:
1952432478
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8770 N BROADWAY
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:
63147-2225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-868-1509
Provider Business Mailing Address Fax Number:
314-868-6683

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8770 N BROADWAY
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:
63147-2225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-868-1509
Provider Business Practice Location Address Fax Number:
314-868-6683
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LAWSON
Authorized Official First Name:
MARICIA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
314-868-1509

Provider Taxonomy Codes

  • Taxonomy code: 372500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 251E00000X , 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: 289715906 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 269715900 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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