1255424628 NPI number — KANSAS PULMONARY AND SLEEP SPECIALISTS CHARTERED

Table of content: (NPI 1255424628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255424628 NPI number — KANSAS PULMONARY AND SLEEP SPECIALISTS CHARTERED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KANSAS PULMONARY AND SLEEP SPECIALISTS CHARTERED
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:
1255424628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12035
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66112-0035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-599-3800
Provider Business Mailing Address Fax Number:
913-599-3854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10550 QUIVIRA RD
Provider Second Line Business Practice Location Address:
SUITE 480
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66215-2306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-599-3800
Provider Business Practice Location Address Fax Number:
913-599-3854
Provider Enumeration Date:
09/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
913-599-3800

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 507712206 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110575 . This is a "BCBS KANSAS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 2053519301 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26005013 . This is a "BCBS KANSAS CITY" identifier . This identifiers is of the category "OTHER".