Provider Demographics
NPI:1770778375
Name:H ANDREW PICKETT MD PC
Entity type:Organization
Organization Name:H ANDREW PICKETT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:H.
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-637-8900
Mailing Address - Street 1:1236 N JESSE JAMES RD
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR SPRG
Mailing Address - State:MO
Mailing Address - Zip Code:64024-1119
Mailing Address - Country:US
Mailing Address - Phone:816-637-8900
Mailing Address - Fax:816-637-4011
Practice Address - Street 1:1236 N JESSE JAMES RD
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRGS
Practice Address - State:MO
Practice Address - Zip Code:64024-1119
Practice Address - Country:US
Practice Address - Phone:816-637-8900
Practice Address - Fax:816-637-4011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6C90207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODD2297OtherMEDICARE RR
MOS740000Medicare PIN
MOE05029Medicare UPIN