1043548142 NPI number — BODYWORX HEALTH CARE SERVICES, P.A.

Table of content: (NPI 1043548142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043548142 NPI number — BODYWORX HEALTH CARE SERVICES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BODYWORX HEALTH CARE SERVICES, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BODYWORX DIABETES EDUCATION & LIFESTYLE MANAGEMENT
Provider Other Organization Name Type Code:
3
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:
1043548142
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4031 E HARRY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67218-3724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-771-7475
Provider Business Mailing Address Fax Number:
316-771-7475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4031 E HARRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67218-3724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-771-7475
Provider Business Practice Location Address Fax Number:
316-771-7475
Provider Enumeration Date:
12/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BARNETT
Authorized Official First Name:
JODIE
Authorized Official Middle Name:
DAWN
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
316-771-7475

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  44997 , 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)





Copyright © 2007-2024 www.npivalidator.com