1740365980 NPI number — THEODORE J KAPANJIE DO

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 1740365980 NPI number — THEODORE J KAPANJIE DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAPANJIE
Provider First Name:
THEODORE
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1740365980
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13100 MANCHESTER RD STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63131-1729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-543-4015
Provider Business Mailing Address Fax Number:
206-363-7335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13100 MANCHESTER RD STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63131-1729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-543-4015
Provider Business Practice Location Address Fax Number:
206-363-7335
Provider Enumeration Date:
10/26/2006

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: 207Q00000X , with the licence number:  2021041951 , 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: 1110KA . This is a "REGENCE RIDER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2500081499 . This is a "MISSOURI BUREAU OF NARCOTICS AND DANGEROUS DRUGS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: P00956630 . This is a "MEDICARE RR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2021041951 . This is a "MISSOURI STATE MEDICAL LICENSE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com