1992026538 NPI number — BARBARA MCDOWELL, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992026538 NPI number — BARBARA MCDOWELL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARBARA MCDOWELL, 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:
1992026538
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6290 RONALD REAGAN DR
Provider Second Line Business Mailing Address:
SUITE 222
Provider Business Mailing Address City Name:
LAKE ST LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63367-2667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-680-1177
Provider Business Mailing Address Fax Number:
636-230-0421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6290 RONALD REAGAN DR
Provider Second Line Business Practice Location Address:
SUITE 222
Provider Business Practice Location Address City Name:
LAKE ST LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63367-2667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-680-1177
Provider Business Practice Location Address Fax Number:
636-230-0421
Provider Enumeration Date:
06/17/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MCDOWELL
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
314-680-1177

Provider Taxonomy Codes

  • Taxonomy code: 364SP0813X , with the licence number:  RN052085 , 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: 4246752221 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 890000994 . This is a "FEDERAL MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 156059 . This is a "ANTHEM BLUE CROSS AND BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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