1003898453 NPI number — MS. JEAN M COVILLO

Table of content: MS. JEAN M COVILLO (NPI 1003898453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003898453 NPI number — MS. JEAN M COVILLO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COVILLO
Provider First Name:
JEAN
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STIMPFEL
Provider Other First Name:
JEAN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN ARNP CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003898453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 S 45TH ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66106-2527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-721-3641
Provider Business Mailing Address Fax Number:
913-721-3649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 S 45TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66106-2527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-721-3641
Provider Business Practice Location Address Fax Number:
913-721-3649
Provider Enumeration Date:
11/18/2005

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: 163W00000X , with the licence number:  108523 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 108523 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 66048A005 . This is a "WPS TRICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: P00369535 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 918614223 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25266032 . This is a "BCBS OF KANSAS CITY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 145350 . This is a "BLUE CROSS BLUE SHIELD KANSAS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 10770 . This is a "PREFERRED HEALTH SYSTEMS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: P00395162 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 406B00014 . This is a "MEDICARE PTAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 10001514701 . This is a "COMMUNITY HEALTH PLAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100254420E , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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