MR. ANDREW JOHN NINICHUCK (NPI# 1609841956) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609841956 |
| Entity Type | Individual |
| Full Name | MR. ANDREW JOHN NINICHUCK |
| Credential | M.D. |
| Practice Address |
527 Benham St Bonne Terre MO 63628-1205 |
| Practice Telephone | 5733589119 |
| Practice Fax Number | 5733589489 |
| Mailing Telephone | 5733589119 |
| Mailing Fax Number | 5733589489 |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2015-11-10 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | 102387 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 1609841956 | 05 |
| Street Address |
527 BENHAM ST |
| City | BONNE TERRE |
| State | MO |
| Zip Code | 63628-1205 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427045004 | Pairat Vibulakaopun | Internal Medicine | 527 Benham St, Bonne Terre, MO 63628-1205 | 2005-09-29 |
| 1669017315 | Patricia Ann Peterson | Nurse Practitioner | 527 Benham St, Bonne Terre, MO 63628-1205 | 2019-11-15 |
| 1225562077 | Ronay Rodgers | Nurse Practitioner | 527 Benham St, Bonne Terre, MO 63628-1205 | 2017-04-19 |
| 1962883751 | Primary Care of Bonne Terre LLC | Clinic/Center | 527 Benham St, Bonne Terre, MO 63628-1205 | 2015-06-17 |
| 1720349970 | Washington County Memorial Hospital | Clinic/Center | 527 Benham St, Bonne Terre, MO 63628-1205 | 2012-06-05 |
| 1891767125 | Constance L Young | Nurse Practitioner | 527 Benham St, Bonne Terre, MO 63628-1205 | 2006-02-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437675477 | Kybama, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 12729 Stoney Point Rd, Bonne Terre, MO 63628 | 2017-08-22 |
| 1295092500 | Jak Properties Inc | In Home Supportive Care | 522 Benham St, Suite B, Bonne Terre, MO 63628 | 2012-04-12 |
| 1013121599 | Joseph Richard Engel | Dentist | 20 W Johnson St, Bonne Terre, MO 63628 | 2007-05-10 |
| 1215093844 | Debra Long Morgan | Dentist | 20 West Johnson Street, Bonne Terre, MO 63628 | 2006-12-28 |
| 1497811459 | Robert Oliver Greenwald | Dentist | #20 W Johnson, Bonne Terre, MO 63628 | 2006-12-27 |
| 1255964508 | American Nursing & Rehab LLC | Assisted Living Facility | 10 Lake Drive, Bonne Terre, MO 63628 | 2020-02-14 |
| 1962679746 | Robert O Greenwald Dds PC | Dentist | #20 W Johnson, Bonne Terre, MO 63628 | 2008-05-12 |
| 1124014030 | Kenny Ratana | Radiology | 527 Benham St # B, Bonne Terre, MO 63628-1205 | 2005-09-26 |
| 1578064796 | Nancy Neece | Counselor | 12 N Allen St, Bonne Terre, MO 63628-1210 | 2018-02-22 |
| 1790958288 | John Paul Lawson Jr. | Pharmacist | 36 N Allen St, Bonne Terre, MO 63628-1210 | 2008-04-07 |
| Find all providers in zip 63628 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790305654 | Remedy Health LLC | General Practice | 37 Doctors Park Ste 3, Cape Girardeau, MO 63703-4903 | 2020-04-21 |
| 1760001598 | Md Sarefin Zaman | General Practice | 2715 W 76 Country Blvd Ste 103, Branson, MO 65616-2344 | 2020-04-12 |
| 1437707551 | Home Docs Medical Associates, LLC | General Practice | 7584 Olive Blvd Ste 204, University City, MO 63130-1600 | 2019-09-02 |
| 1912462912 | Thomas George Brett | General Practice | 800 Missouri 248, Building 3 Suite A, Branson, MO 65616 | 2019-02-04 |
| 1295208403 | Sme Kentucky Psc | General Practice | 5728 Pergola Dr Apt 207, Columbia, MO 65201-2897 | 2019-01-10 |
| 1821579798 | Healthy Schools Missouri LLC | General Practice | 3675 S Noland Rd Ste 200, Independence, MO 64055-3369 | 2018-08-28 |
| 1902300825 | Landmark Medical of Missouri PC | General Practice | 312 Sw Greenwich Dr # 315, Lees Summit, MO 64082-4408 | 2018-03-23 |
| 1740784214 | Bridge Integrative Medicine LLC | General Practice | 305 Nw Englewood Ct Ste 200, Kansas City, MO 64118 | 2018-03-20 |
| 1093218224 | Andrew Jason Doppelt | General Practice | 200 E Southampton Dr Ste 104, Columbia, MO 65203-3032 | 2018-03-14 |
| 1114427606 | Khrystal Robinson | General Practice | 902 E Reed St, Hayti, MO 63851-1243 | 2018-02-20 |
| Find all providers with the same taxonomy | ||||
| City | BONNE TERRE |
| Zip Code | 63628 |
Please comment or provide details below to improve the information on MR. ANDREW JOHN NINICHUCK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.