1558356329 NPI number — MATTHEW R. GAGE, D.C.,P.A.

Table of content: (NPI 1558356329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558356329 NPI number — MATTHEW R. GAGE, D.C.,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MATTHEW R. GAGE, D.C.,P.A.
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:
1558356329
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 E MADISON AVE
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
DERBY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67037-3000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-788-3713
Provider Business Mailing Address Fax Number:
316-788-3231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 E MADISON AVE
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
DERBY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67037-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-788-3713
Provider Business Practice Location Address Fax Number:
316-788-3231
Provider Enumeration Date:
09/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GAGE
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
316-788-3713

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  01-033389 , 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)

  • Identifier: 062064 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 8196 . This is a "PREFERRED HEALTH SYSTEMS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 007277 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: N612 . This is a "PREFERRED HEALTH SYSTEMS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com