1073572244 NPI number — PARTNERS IN PEDIATRICS PA

Table of content: (NPI 1073572244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073572244 NPI number — PARTNERS IN PEDIATRICS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARTNERS IN PEDIATRICS PA
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:
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:
1073572244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6021 SW 29TH ST
Provider Second Line Business Mailing Address:
SUITE A PMB 374
Provider Business Mailing Address City Name:
TOPEKA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66614-6200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-272-1903
Provider Business Mailing Address Fax Number:
785-272-5711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
631 SW HORNE ST
Provider Second Line Business Practice Location Address:
SUITE 340
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66606-1694
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-234-4624
Provider Business Practice Location Address Fax Number:
785-234-4791
Provider Enumeration Date:
03/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HEEB
Authorized Official First Name:
CAMILLE
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
785-234-4624

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 016818 . This is a "BCBSKS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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