1174589865 NPI number — THOMAS A KRISS DDS

Table of content: THOMAS A KRISS DDS (NPI 1174589865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174589865 NPI number — THOMAS A KRISS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRISS
Provider First Name:
THOMAS
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
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:
1174589865
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1212 CHESTNUT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EMPORIA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-342-8256
Provider Business Mailing Address Fax Number:
620-412-4316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1212 CHESTNUT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-342-8256
Provider Business Practice Location Address Fax Number:
620-412-4316
Provider Enumeration Date:
04/22/2006

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: 1223G0001X , with the licence number:  KS7081 , 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: 116835 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100289310B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1005132 . This is a "DORAL PROVIDER ID" identifier . This identifiers is of the category "OTHER".