1063411999 NPI number — DR. JAMES J SPADARO JR. M.D.

Table of content: DR. JAMES J SPADARO JR. M.D. (NPI 1063411999)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063411999 NPI number — DR. JAMES J SPADARO JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPADARO
Provider First Name:
JAMES
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1063411999
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 W 10TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROLLA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65401-2905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-308-1301
Provider Business Mailing Address Fax Number:
573-202-2480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 W 10TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROLLA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65401-2905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-308-1301
Provider Business Practice Location Address Fax Number:
573-202-2480
Provider Enumeration Date:
07/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  R9324 , 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: 10372 . This is a "BC/BS ID#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43-1571021 . This is a "TAX ID#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 145792 . This is a "HEALTHLINK ID#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4040796 . This is a "AETNA ID#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202587614 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8712 . This is a "GHP ID#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202587622 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2500043 . This is a "UHC ID#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5512255 . This is a "CIGNA ID#" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com