1255365318 NPI number — WAMEGO CRNA

Table of content: (NPI 1255365318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255365318 NPI number — WAMEGO CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAMEGO CRNA
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:
WAMEGO HOSPITAL ASSOCIATION
Provider Other Organization Name Type Code:
5
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:
1255365318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
711 GENN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAMEGO
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66547-1179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-456-2295
Provider Business Mailing Address Fax Number:
785-456-9467

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
711 GENN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAMEGO
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66547-1179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-456-2295
Provider Business Practice Location Address Fax Number:
785-456-9467
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAKIN
Authorized Official First Name:
ALYCEA
Authorized Official Middle Name:
Authorized Official Title or Position:
PATIENT ACCOUNTS COORDINATOR
Authorized Official Telephone Number:
785-456-2295

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 144683 . This is a "C. BROWN/ BLUE CROSS #" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 144577 . This is a "C.ROSE/BLUE CROSS #" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 144576 . This is a "WAMEGO CRNA BLUE CROSS #" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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