1598836678 NPI number — WCP LABORATORIES, INC

Table of content: (NPI 1598836678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598836678 NPI number — WCP LABORATORIES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WCP LABORATORIES, 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:
1598836678
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2326 MILLPARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARYLAND HEIGHTS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63043-3530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-991-4313
Provider Business Mailing Address Fax Number:
314-991-4317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2326 MILLPARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARYLAND HEIGHTS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63043-3530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-991-4313
Provider Business Practice Location Address Fax Number:
314-991-4317
Provider Enumeration Date:
11/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRENZ
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
314-991-4313

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  14D0913186 , 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: 131223 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 000012921 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 26847 . This is a "GROUP HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 113515 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 708658307 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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