Provider Demographics
NPI:1114104114
Name:RICK HUMMEL MD PC
Entity Type:Organization
Organization Name:RICK HUMMEL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:HUMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-741-1400
Mailing Address - Street 1:11155 DUNN RD
Mailing Address - Street 2:201N
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136
Mailing Address - Country:US
Mailing Address - Phone:314-741-1400
Mailing Address - Fax:314-741-0175
Practice Address - Street 1:11155 DUNN RD
Practice Address - Street 2:201N
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136
Practice Address - Country:US
Practice Address - Phone:314-741-1400
Practice Address - Fax:314-741-0175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3D69207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOCI5813OtherRR MEDICARE
MO150936OtherBC
MO31886OtherGHP
MO202626305Medicaid
MO31886OtherGHP