1508868159 NPI number — DR. JEFFREY P GIRKIN MD

Table of content: DR. JEFFREY P GIRKIN MD (NPI 1508868159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508868159 NPI number — DR. JEFFREY P GIRKIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIRKIN
Provider First Name:
JEFFREY
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1508868159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 414965
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:
64141-4965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-234-1350
Provider Business Mailing Address Fax Number:
913-234-1108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 W R D MIZE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUE SPRINGS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64014-2518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-228-5900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2005

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: 207P00000X , with the licence number:  100662 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207PE0005X , with the licence number: 100662 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 19531036 . This is a "BCBS MO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".