1851731020 NPI number — TASIA K FARLEY LMLP

Table of content: TASIA K FARLEY LMLP (NPI 1851731020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851731020 NPI number — TASIA K FARLEY LMLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARLEY
Provider First Name:
TASIA
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YOUNG
Provider Other First Name:
TASIA
Provider Other Middle Name:
K
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:
1851731020
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 W 16TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLINGTON
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67152-8125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-326-7448
Provider Business Mailing Address Fax Number:
620-326-6662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 W 16TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67152-8125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-326-7448
Provider Business Practice Location Address Fax Number:
620-326-6662
Provider Enumeration Date:
07/02/2013

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: 103TC1900X , with the licence number:  2473 , 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: 201076600A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".