1114964798 NPI number — DENNIS M HANDLEY MD

Table of content: DENNIS M HANDLEY MD (NPI 1114964798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114964798 NPI number — DENNIS M HANDLEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANDLEY
Provider First Name:
DENNIS
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1114964798
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 88
Provider Second Line Business Mailing Address:
17651 B. HIGHWAY
Provider Business Mailing Address City Name:
BOONVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65233-0088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-882-2121
Provider Business Mailing Address Fax Number:
660-882-7073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17601 B HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOONVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65233-2839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-882-2121
Provider Business Practice Location Address Fax Number:
660-882-7073
Provider Enumeration Date:
06/01/2006

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: 207Q00000X , with the licence number:  MDR7966 , 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: 201300019 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 80052848 . This is a "RR MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 104106 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2086349401 . This is a "KANSAS MEDICAID" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 9098 . This is a "BLUE SHIELD/BLUE CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 102982 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 500300006 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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