1922194505 NPI number — BRIAN DAVID CALKINS PA-C

Table of content: BRIAN DAVID CALKINS PA-C (NPI 1922194505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922194505 NPI number — BRIAN DAVID CALKINS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALKINS
Provider First Name:
BRIAN
Provider Middle Name:
DAVID
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1922194505
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:
7921 ROCKWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-210-1681
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
IRWIN ARMY COMMUNITY HOSIPITAL
Provider Second Line Business Practice Location Address:
600 CASSION HILL RD,
Provider Business Practice Location Address City Name:
FORT RILEY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66442-5037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-239-7155
Provider Business Practice Location Address Fax Number:
785-239-7364
Provider Enumeration Date:
10/04/2006

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: 363A00000X , with the licence number:  00361 , 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)