1790794089 NPI number — FAMILY PRACTICE ASSOCIATES CHTD

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 1790794089 NPI number — FAMILY PRACTICE ASSOCIATES CHTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY PRACTICE ASSOCIATES CHTD
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:
1790794089
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12066
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66112-0066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-299-4966
Provider Business Mailing Address Fax Number:
913-299-4205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1150 N 75TH PL
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66112-3302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-299-2100
Provider Business Practice Location Address Fax Number:
913-299-4205
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PALMERI
Authorized Official First Name:
VICENTE
Authorized Official Middle Name:
CARLOS
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
913-299-2100

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: C470000 . This is a "MEDICARE PTAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: C470000A . This is a "MEDICARE PTAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100289320B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100289320A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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