Provider Demographics
NPI:1407125560
Name:BIRMES, CHARLES
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:BIRMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 GOLDEN POND
Mailing Address - Street 2:
Mailing Address - City:VILLA RIDGE
Mailing Address - State:MO
Mailing Address - Zip Code:63089-2156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5800 GOLDEN POND
Practice Address - Street 2:
Practice Address - City:VILLA RIDGE
Practice Address - State:MO
Practice Address - Zip Code:63089-2156
Practice Address - Country:US
Practice Address - Phone:314-560-3166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010033520164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse