1184622730 NPI number — MIDWEST EAR NOSE AND THROAT LLC

Table of content: (NPI 1184622730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184622730 NPI number — MIDWEST EAR NOSE AND THROAT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST EAR NOSE AND THROAT LLC
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:
1184622730
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 874480
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:
64187-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-764-2737
Provider Business Mailing Address Fax Number:
913-764-7502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20375 W 151ST ST
Provider Second Line Business Practice Location Address:
STE #106
Provider Business Practice Location Address City Name:
OLATHE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-764-2737
Provider Business Practice Location Address Fax Number:
913-764-7502
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
METZ
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
913-764-2737

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CE8450 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 14136024 . This is a "BCBS - KC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110356 . This is a "KS MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 702788 . This is a "BCBS - KS" identifier . This identifiers is of the category "OTHER".
  • Identifier: D44000 . This is a "KC MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com