1083610539 NPI number — GWENDOLYN ARNETT MD

Table of content: GWENDOLYN ARNETT MD (NPI 1083610539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083610539 NPI number — GWENDOLYN ARNETT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARNETT
Provider First Name:
GWENDOLYN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1083610539
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 504407
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63150-4407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-932-7940
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4321 WASHINGTON ST
Provider Second Line Business Practice Location Address:
STE 1000
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64111-5961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-932-2307
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2005

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: 2085R0202X , with the licence number:  0418805 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085B0100X , with the licence number: R5C04 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: R5C04 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100153570B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00152870 . This is a "RR MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 2050520001 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300089670 . This is a "RR MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: P00152851 . This is a "RR MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 202351714 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 202351772 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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