1801018536 NPI number — DR. JOHN STEVEN BRADLEY DO

Table of content: DR. JOHN STEVEN BRADLEY DO (NPI 1801018536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801018536 NPI number — DR. JOHN STEVEN BRADLEY DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRADLEY
Provider First Name:
JOHN
Provider Middle Name:
STEVEN
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:
1801018536
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9100 W 74TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHAWNEE MISSION
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66204-4004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-676-2214
Provider Business Mailing Address Fax Number:
913-789-3106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9100 W 74TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHAWNEE MISSION
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66204-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-676-2214
Provider Business Practice Location Address Fax Number:
913-789-3106
Provider Enumeration Date:
05/03/2007

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: 207P00000X , with the licence number:  32784 , 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: P00681220 . This is a "RR MEDICARE NUMBER FOR GROUP DC6712" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 1801018536 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200564180A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00635002 . This is a "RR MEDICARE GROUP CG8899" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 40359018 . This is a "BCBS KCMO SMMC EMERGENCY PHYSICIANS GROUP 01674018" identifier . This identifiers is of the category "OTHER".
  • Identifier: 40359028 . This is a "BCBS KCMO ER PHYSICIANS SOUTH PA GROUP 30492021" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200564180B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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