1962698837 NPI number — UNIVERSITY HEMATOLOGY ONCOLOGY GROUP INC.

Table of content: (NPI 1962698837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962698837 NPI number — UNIVERSITY HEMATOLOGY ONCOLOGY GROUP INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY HEMATOLOGY ONCOLOGY GROUP INC.
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:
1962698837
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4921 PARKVIEW PL
Provider Second Line Business Mailing Address:
SUITE 14C
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63110-1032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-290-7501
Provider Business Mailing Address Fax Number:
314-290-7575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1052 MARTIN LUTHER KING DR
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
CENTRALIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62801-3002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-290-7501
Provider Business Practice Location Address Fax Number:
314-290-7575
Provider Enumeration Date:
09/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SYED
Authorized Official First Name:
RAZA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
314-290-7501

Provider Taxonomy Codes

  • Taxonomy code: 207RX0202X , with the licence number:  36-043159 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8221935 . This is a "BCBS IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com