1174561237 NPI number — DEBORAH LOCKWOOD PA-C

Table of content: DEBORAH LOCKWOOD PA-C (NPI 1174561237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174561237 NPI number — DEBORAH LOCKWOOD PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOCKWOOD
Provider First Name:
DEBORAH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1174561237
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2330 SHAWNEE MISSION PKWY
Provider Second Line Business Mailing Address:
MEDICAL ADMINISTRATIVE SERVICES OF KU MED, STE. 312
Provider Business Mailing Address City Name:
WESTWOOD
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66205-2005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-588-9000
Provider Business Mailing Address Fax Number:
913-588-9822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7405 RENNER RD
Provider Second Line Business Practice Location Address:
KU MEDWEST
Provider Business Practice Location Address City Name:
SHAWNEE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66217-9414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-588-8400
Provider Business Practice Location Address Fax Number:
913-588-8413
Provider Enumeration Date:
06/02/2006

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: 363A00000X , with the licence number:  15-01030 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: 117957 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 928367 . This is a "FIRSTGUARD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200334360A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 481159444 . This is a "JAYHAWK TAX ID" identifier . This identifiers is of the category "OTHER".




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