1881770469 NPI number — DR. NICHOLAS A NAVATO D.O.

Table of content: DR. NICHOLAS A NAVATO D.O. (NPI 1881770469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881770469 NPI number — DR. NICHOLAS A NAVATO D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAVATO
Provider First Name:
NICHOLAS
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NAVATO
Provider Other First Name:
NICK
Provider Other Middle Name:
ANTONIO
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1881770469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3445 S STATE ROUTE 291
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64057-2663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-373-8715
Provider Business Mailing Address Fax Number:
816-795-9388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3445 S STATE ROUTE 291
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64057-2663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-373-8715
Provider Business Practice Location Address Fax Number:
816-795-9388
Provider Enumeration Date:
10/27/2006

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: 208100000X , with the licence number:  102395 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208100000X , with the licence number: 05-27198 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 8004A0001 . This is a "MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: MA 2398001 . This is a "MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".