Provider Demographics
NPI:1366692303
Name:PAUL M. PACKMAN INC.
Entity Type:Organization
Organization Name:PAUL M. PACKMAN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-727-1666
Mailing Address - Street 1:8301 MARYLAND AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105
Mailing Address - Country:US
Mailing Address - Phone:314-727-1666
Mailing Address - Fax:314-727-5488
Practice Address - Street 1:8301 MARYLAND AVE.
Practice Address - Street 2:SUITE 320
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105
Practice Address - Country:US
Practice Address - Phone:314-727-1666
Practice Address - Fax:314-727-5488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO291932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200743300Medicaid
MO826262307OtherRAILROAD MEDICARE
MO000005191OtherMO MEDICARE SERVICES
MO200743300Medicaid