1518089374 NPI number — DRS GLENN & GLENN INC

Table of content: (NPI 1518089374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518089374 NPI number — DRS GLENN & GLENN INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS GLENN & GLENN INC
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:
CORPORATION
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:
1518089374
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
702 N KANSAS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUSSELL
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67665-2043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-483-2451
Provider Business Mailing Address Fax Number:
785-798-4986

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
702 N KANSAS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSSELL
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67665-2043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-483-2451
Provider Business Practice Location Address Fax Number:
785-798-4986
Provider Enumeration Date:
04/04/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BANKS
Authorized Official First Name:
MELANIE
Authorized Official Middle Name:
B
Authorized Official Title or Position:
TECHNICIAN
Authorized Official Telephone Number:
785-483-2451

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  11533 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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