Provider Demographics
NPI:1972597136
Name:ARMSTRONG, JEFFERY O (PA C)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:O
Last Name:ARMSTRONG
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 PATIENTS FIRST DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-4700
Mailing Address - Country:US
Mailing Address - Phone:636-390-1595
Mailing Address - Fax:636-390-1596
Practice Address - Street 1:901 PATIENTS FIRST DR
Practice Address - Street 2:SUITE 300
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-4700
Practice Address - Country:US
Practice Address - Phone:636-390-1595
Practice Address - Fax:636-390-1596
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003793363A00000X, 363AM0700X, 363AS0400X
MO2013028988363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01250863OtherRAILROAD MEDICARE
GAP00185784OtherRAILROAD MEDICARE
GA100001710DMedicaid
GADC4061OtherRAILROAD MEDICARE
GA100001710DMedicaid
MOMA4174002Medicare PIN
GAGRP6800Medicare PIN
MOP01250863OtherRAILROAD MEDICARE
P48731Medicare UPIN