1174589428 NPI number — TEMME L MARTIN FNP

Table of content: TEMME L MARTIN FNP (NPI 1174589428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174589428 NPI number — TEMME L MARTIN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
TEMME
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLER
Provider Other First Name:
TEMME
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174589428
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2301 HOLMES ST
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:
64108-2640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-404-1000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 HOLMES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64108-2640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-404-1075
Provider Business Practice Location Address Fax Number:
816-404-1082
Provider Enumeration Date:
04/25/2006

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: 363LF0000X , with the licence number:  102671 , 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: 595956202 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01157151 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 595956400 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34604027 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 595985805 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010568509 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 427226303 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 599225901 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 540568508 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 595956103 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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