1710917430 NPI number — JASON T TAUKE MD PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710917430 NPI number — JASON T TAUKE MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JASON T TAUKE MD PA
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:
1710917430
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9350 E 35TH ST N
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67226-2019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-265-1308
Provider Business Mailing Address Fax Number:
316-712-9286

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9350 E 35TH ST N
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67226-2019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-265-1308
Provider Business Practice Location Address Fax Number:
316-712-9286
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAMSTACK
Authorized Official First Name:
DEBBIE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
ADM ASST
Authorized Official Telephone Number:
316-712-9233

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DE2154 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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