1710996640 NPI number — STEVEN A GARNER MD

Table of content: STEVEN A GARNER MD (NPI 1710996640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710996640 NPI number — STEVEN A GARNER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARNER
Provider First Name:
STEVEN
Provider Middle Name:
A
Provider Name Prefix Text:
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:
1710996640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8035
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-689-9135
Provider Business Mailing Address Fax Number:
316-689-9667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1640 E TALL TREE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DERBY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-789-8222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2006

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: 207Q00000X , with the licence number:  04-25918 , 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: 100283640F , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003719062 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".