1215198023 NPI number — JAMES K. MCENTIRE, D.O., P.C.

Table of content: (NPI 1215198023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215198023 NPI number — JAMES K. MCENTIRE, D.O., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES K. MCENTIRE, D.O., P.C.
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:
PREFERRED PEDIATRICS
Provider Other Organization Name Type Code:
3
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:
1215198023
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
241 NW MCNARY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEES SUMMIT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64086-4011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-347-0064
Provider Business Mailing Address Fax Number:
816-347-0593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
241 NW MCNARY CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEES SUMMIT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64086-4011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-347-0064
Provider Business Practice Location Address Fax Number:
816-347-0593
Provider Enumeration Date:
06/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MCENTIRE
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
SECRECTARY OF CORPORATION
Authorized Official Telephone Number:
816-347-0064

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 700856 . This is a "MERCY CAREPLUS, SHERRI QUICK, RN, CPNP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 205839806 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29963014 . This is a "BLUE CROSS BLUE SHIELD OF KANSAS CITY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: A0529165 . This is a "UNICARE, DR. MCENTIRE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100380340C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 248124828 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33338 . This is a "HEALTHCARE USA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 420629800 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100419760C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: A0429720 . This is a "UNICARE, DR. GRAHAM" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 61581 . This is a "HEALTHCARE USA, SHERRI QUICK, RN, CPNP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 890896 . This is a "MERCY CAREPLUS, DR. MCENTIRE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 39784 . This is a "HEALTHCARE USA , DR. GRAHAM" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 890907 . This is a "MERCY CAREPLUS, DR. GRAHAM" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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