1023018827 NPI number — MICHAEL A SABOLOVIC M.S.P.T., M.T.C.

Table of content: MICHAEL A SABOLOVIC M.S.P.T., M.T.C. (NPI 1023018827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023018827 NPI number — MICHAEL A SABOLOVIC M.S.P.T., M.T.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SABOLOVIC
Provider First Name:
MICHAEL
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S.P.T., M.T.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:
1023018827
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5799 BROADMOOR ST
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
MISSION
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66202-2403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-384-5600
Provider Business Mailing Address Fax Number:
913-384-0719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5799 BROADMOOR ST
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
MISSION
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66202-2403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-384-5600
Provider Business Practice Location Address Fax Number:
913-384-0719
Provider Enumeration Date:
07/22/2005

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: 225100000X , with the licence number:  11-02336 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 2001018689 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 501071 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 731060 . This is a "HEALTHCARE PREFERRED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 650019070 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: T66E306 . This is a "MEDICARE B - KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 24598014 . This is a "BLUE CROSS BLUE SHIELD KC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43181441066202A002 . This is a "TRICARE - KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 24598 . This is a "PREFERRED HEALTH PROFESS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4000127 . This is a "MULTIPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8271336 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: T66E306A . This is a "MEDICARE B - MO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 43181441064155A004 . This is a "TRICARE - MO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 534021 . This is a "BLUE CROSS BLUE SHIELD KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 1239683 . This is a "FIRST HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 440238 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".




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