1306897509 NPI number — FELICITAS Z GATCHALIAN MD

Table of content: FELICITAS Z GATCHALIAN MD (NPI 1306897509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306897509 NPI number — FELICITAS Z GATCHALIAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GATCHALIAN
Provider First Name:
FELICITAS
Provider Middle Name:
Z
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1306897509
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1035 BELLEVUE AVE
Provider Second Line Business Mailing Address:
SUITE 411
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63117-1854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-644-3433
Provider Business Mailing Address Fax Number:
314-644-3235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
514 S 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VINCENNES
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47591-2709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-885-6990
Provider Business Practice Location Address Fax Number:
812-885-6991
Provider Enumeration Date:
05/12/2006

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: 207R00000X , with the licence number:  36374 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 01069188A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 201804721 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com