1073613444 NPI number — DR. MARTIN L DE RUYTER MD

Table of content: DR. MARTIN L DE RUYTER MD (NPI 1073613444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073613444 NPI number — DR. MARTIN L DE RUYTER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE RUYTER
Provider First Name:
MARTIN
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1073613444
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3901 RAINBOW BLVD
Provider Second Line Business Mailing Address:
DEPT ANESTHESIOLOGY, MAIL STOP 1034
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-588-6670
Provider Business Mailing Address Fax Number:
913-588-3365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3901 RAINBOW BLVD
Provider Second Line Business Practice Location Address:
DEPT ANESTHESIOLOGY, MAIL STOP 1034
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-588-6670
Provider Business Practice Location Address Fax Number:
913-588-3365
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  04-30537 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LC0200X , with the licence number: 04-30537 , 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)

  • Identifier: 34101011 . This is a "BCBS KANSAS CITY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 209352103 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200263180A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 476960 . This is a "FIRSTGUARD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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