1619981388 NPI number — MR. JOHN S HIRSCHFELD MA

Table of content: MR. JOHN S HIRSCHFELD MA (NPI 1619981388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619981388 NPI number — MR. JOHN S HIRSCHFELD MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HIRSCHFELD
Provider First Name:
JOHN
Provider Middle Name:
S
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MA
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:
1619981388
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1430 OLIVE ST
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63103-2303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-206-3966
Provider Business Mailing Address Fax Number:
314-206-3708

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3165 MCKELVEY RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BRIDGETON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63044-2550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-206-3966
Provider Business Practice Location Address Fax Number:
314-206-3992
Provider Enumeration Date:
07/28/2006

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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