1730189457 NPI number — AMANDA DYAN GRINDEL P.T.A.

Table of content: AMANDA DYAN GRINDEL P.T.A. (NPI 1730189457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730189457 NPI number — AMANDA DYAN GRINDEL P.T.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRINDEL
Provider First Name:
AMANDA
Provider Middle Name:
DYAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEPRIEST
Provider Other First Name:
AMANDA
Provider Other Middle Name:
DYAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730189457
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8516 N OAK TRFY
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:
64155-2433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-436-4500
Provider Business Mailing Address Fax Number:
816-436-4510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8516 N OAK TRFY
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:
64155-2433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-436-4500
Provider Business Practice Location Address Fax Number:
816-436-4510
Provider Enumeration Date:
07/22/2005

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: 225200000X , with the licence number:  14-01647 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X , with the licence number: 2002003114 , 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)