1184686602 NPI number — CLEARVIEW MOBILE IMAGING LLC

Table of content: THYRA KRISTIN DEWEY PTA (NPI 1326387911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184686602 NPI number — CLEARVIEW MOBILE IMAGING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEARVIEW MOBILE IMAGING LLC
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:
1184686602
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
306 S BELT HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT JOSEPH
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64506-3418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-232-2727
Provider Business Mailing Address Fax Number:
816-232-2771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11912 ELM ST
Provider Second Line Business Practice Location Address:
SUITE 122
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68144-4387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-232-2727
Provider Business Practice Location Address Fax Number:
816-232-2771
Provider Enumeration Date:
04/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EVANS
Authorized Official First Name:
ZACHARY
Authorized Official Middle Name:
B
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
816-232-2727

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100251900 . This is a "MEDICAID" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 0586552 . This is a "MEDICAID" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 10025190700 . This is a "MEDICAID" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 099607 . This is a "MEDICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 717253009 . This is a "MEDICAID" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: I14667 . This is a "MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: P00181866 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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