Provider Demographics
NPI:1720332018
Name:HAMID A HOSSEINI MD PC
Entity Type:Organization
Organization Name:HAMID A HOSSEINI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOSSEINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-831-6517
Mailing Address - Street 1:1224 GRAHAM RD
Mailing Address - Street 2:SUITE 1104
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8028
Mailing Address - Country:US
Mailing Address - Phone:314-831-6517
Mailing Address - Fax:314-831-3421
Practice Address - Street 1:1224 GRAHAM RD
Practice Address - Street 2:SUITE 1104
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8028
Practice Address - Country:US
Practice Address - Phone:314-831-6517
Practice Address - Fax:314-831-3421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7H07207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208108613Medicaid
MO208108613Medicaid