1104813732 NPI number — MICHAEL C TRENDLE M.D.

Table of content: MICHAEL C TRENDLE M.D. (NPI 1104813732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104813732 NPI number — MICHAEL C TRENDLE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRENDLE
Provider First Name:
MICHAEL
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1104813732
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 843966
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64184-3966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-884-3300
Provider Business Mailing Address Fax Number:
573-884-0943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65212-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-882-8445
Provider Business Practice Location Address Fax Number:
573-884-7822
Provider Enumeration Date:
09/29/2005

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: 207RH0003X , with the licence number:  112173 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110281 . This is a "BCBS OF MO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 208702308 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 28104 . This is a "GHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5132415 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 333188 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3600181 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: F44709 . This is a "MERCY HEALTH PLANS" identifier . This identifiers is of the category "OTHER".




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