1053388660 NPI number — MR. LAWRENCE L RUDER MA CCCA

Table of content: MR. LAWRENCE L RUDER MA CCCA (NPI 1053388660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053388660 NPI number — MR. LAWRENCE L RUDER MA CCCA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUDER
Provider First Name:
LAWRENCE
Provider Middle Name:
L
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MA CCCA
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:
1053388660
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7301 MISSION RD STE 146
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRAIRIE VILLAGE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66208-3005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-384-2105
Provider Business Mailing Address Fax Number:
913-384-0735

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12330 METCALF AVE
Provider Second Line Business Practice Location Address:
SUITE 560
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66213-1324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-498-2827
Provider Business Practice Location Address Fax Number:
913-498-1052
Provider Enumeration Date:
03/02/2006

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: 231H00000X , with the licence number:  867 , 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: 100398800A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14105034 . This is a "BCBS OF KANSAS CITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 640004509 . This is a "TRAVELERS MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 481106646 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7184252 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: LE714 . This is a "HEARING AID DISPENSING LI" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: P33678 . This is a "COVENTRY" identifier . This identifiers is of the category "OTHER".




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