1003140781 NPI number — MS. FAYE CLARE MAHER JURADO L.P.C. & L.M.A.C

Table of content: MS. FAYE CLARE MAHER JURADO L.P.C. & L.M.A.C (NPI 1003140781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003140781 NPI number — MS. FAYE CLARE MAHER JURADO L.P.C. & L.M.A.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAHER JURADO
Provider First Name:
FAYE
Provider Middle Name:
CLARE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.P.C. & L.M.A.C
Provider Gender Code:
F

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:
1003140781
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12311 W 79TH TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LENEXA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66215-2603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-203-8939
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6331 W 110TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66211-1509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-696-1911
Provider Business Practice Location Address Fax Number:
913-696-1619
Provider Enumeration Date:
09/28/2009

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: 101YA0400X , with the licence number:  697 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 2139 , 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: 101YA0400X , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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