1245255983 NPI number — DR. SHEENA S DRAKE MD

Table of content: DR. SHEENA S DRAKE MD (NPI 1245255983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245255983 NPI number — DR. SHEENA S DRAKE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DRAKE
Provider First Name:
SHEENA
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
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:
1245255983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 HEARTLAND RD STE 2800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT JOSEPH
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64506-6201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-271-1200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 HEARTLAND RD
Provider Second Line Business Practice Location Address:
SUITE 2800
Provider Business Practice Location Address City Name:
SAINT JOSEPH
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64506-6200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-271-1085
Provider Business Practice Location Address Fax Number:
816-271-1216
Provider Enumeration Date:
07/13/2006

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: 207V00000X , with the licence number:  2001012416 , 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: 414780 . This is a "FIRSTGUARD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 465450 . This is a "CHILDRENS MERCY FAMILY HEALTH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 44054528964506V019 . This is a "CHAMPUS/TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7482263 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00037736 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 29840029 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 100401700B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 477436 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10001554801 . This is a "COMMUNITY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 205362700 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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