1821099805 NPI number — DR. GLENN RICHARD KUBINA MD

Table of content: DR. GLENN RICHARD KUBINA MD (NPI 1821099805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821099805 NPI number — DR. GLENN RICHARD KUBINA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUBINA
Provider First Name:
GLENN
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
DR.
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:
1821099805
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
818 N EMPORIA
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67214-2193
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-263-0296
Provider Business Mailing Address Fax Number:
316-684-3326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 S HILLSIDE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67211-2193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-684-2838
Provider Business Practice Location Address Fax Number:
316-684-3326
Provider Enumeration Date:
08/02/2005

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: 207Y00000X , with the licence number:  18133 , 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: 200812 . This is a "HEALTH PARTNERS OF KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 4070625 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101367 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 1865563004 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 504 . This is a "PREFERRED HEALTH SYSTEMS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 101367 . This is a "WAL-MART" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 504 . This is a "PREFERRED PLUS OF KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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