1053515973 NPI number — MEADOWLARK MEDICAL SERVICES, PA

Table of content: (NPI 1053515973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053515973 NPI number — MEADOWLARK MEDICAL SERVICES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEADOWLARK MEDICAL SERVICES, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053515973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3210 MERSINGTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64128-2143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-813-8308
Provider Business Mailing Address Fax Number:
816-924-3223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 N 12TH ST STE 103A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66102-5161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-531-0110
Provider Business Practice Location Address Fax Number:
816-531-0115
Provider Enumeration Date:
06/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BROCKENBROUGH
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
816-813-8308

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  2009015153 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208G00000X , with the licence number: 0432320 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)