1952550485 NPI number — DOROTHY M. MUNCH, D.O., LLC

Table of content: (NPI 1952550485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952550485 NPI number — DOROTHY M. MUNCH, D.O., LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOROTHY M. MUNCH, D.O., 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:
6
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:
1952550485
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
930 N WESTWOOD BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POPLAR BLUFF
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63901-4242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-778-1620
Provider Business Mailing Address Fax Number:
573-778-1486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
930 N WESTWOOD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POPLAR BLUFF
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63901-4242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-778-1620
Provider Business Practice Location Address Fax Number:
573-778-1486
Provider Enumeration Date:
09/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MCALISTER
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
573-778-1697

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  36720 , 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: 164653 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 242613084 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26D1003101 . This is a "CLIA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 000000E14668 . This is a "PREMIER BENEFITS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 915331 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00109903 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1922003276 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 242613073 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com