1568455988 NPI number — DR. KEVIN P HUBBARD DO

Table of content: DR. KEVIN P HUBBARD DO (NPI 1568455988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568455988 NPI number — DR. KEVIN P HUBBARD DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUBBARD
Provider First Name:
KEVIN
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1568455988
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1750 INDEPENDENCE AVE
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:
64106-1453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-654-7393
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1750 INDEPENDENCE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64106-1453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-654-7393
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2005

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: 207RH0002X , with the licence number:  05-28154 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 05-28154 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: DO36829 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11375 . This is a "COVENTRY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 14344028 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4534636 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 560421 . This is a "FIRSTGURARD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 026295099 . This is a "BLACK LUNG" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 100014578 . This is a "COMMUNITY HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 3650052 . This is a "UHC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 700038 . This is a "BCBS KANSAS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 243356409 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12441 . This is a "HM CARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 97760 . This is a "ADVANTRA MEDICARE HMO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 480911591029 . This is a "CIGNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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