NPI Record of ME'TIS BREAST CARE (STE GENEVIEVE COUNTY MEMORIAL HOSPITAL) NPI 1295030807

Clinic/Center (Medical Specialty) in Ste Genevieve, MO

Complete NPI Record

Field Name Value Definition
NPI1295030807The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code2Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EINUNAVAILThe Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business NameSTE GENEVIEVE COUNTY MEMORIAL HOSPITALThe name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization NameME'TIS BREAST CAREOther name by which the organization provider is or has been known.
Provider Other Organization Name Type Code3Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address120 PLAZA DRThe first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City NameSTE GENEVIEVEThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameMOThe State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code636701828The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number5738835717The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number5738833684The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address120 PLAZA DRThe first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameSTE GENEVIEVEThe city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameMOThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code636701828The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USThe country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number5738832782The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number5738833684The fax number associated with the location address of the provider being identified.
Provider Enumeration Date1/13/2011The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date9/9/2020The date that a record was last updated or changed.
Authorized Official Last NameBRANSTETTERThe last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameJONThe first name of the authorized official.
Authorized Official Title or PositionCFOThe title or position of the authorized official.
Authorized Official Telephone Number5738837714The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1261QM2500XCode designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1Y
Other Provider Identifier 1504887308Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 105Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1MO
Other Provider Identifier 2CC8331Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 201Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2MO
Other Provider Identifier Issuer 2RAILROAD MEDICARE
Is Organization SubpartN
NPI Certification Date9/9/2020