1053318287 NPI number — DR. BARBARA K TULEY MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053318287 NPI number — DR. BARBARA K TULEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TULEY
Provider First Name:
BARBARA
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TULEY
Provider Other First Name:
BARBARA
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1053318287
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 EL RANCHO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HANNIBAL
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63401-6622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-429-6002
Provider Business Mailing Address Fax Number:
573-719-3480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 EL RANCHO DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HANNIBAL
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63401-6622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-429-6002
Provider Business Practice Location Address Fax Number:
573-719-3480
Provider Enumeration Date:
07/01/2005

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: 207R00000X , with the licence number:  17220 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200050875 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 731381304 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 731510332 . This is a "CHAMPUS/CHAMPVA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100185800A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110172670 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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