1194967778 NPI number — OCCUPATIONAL & PREVENTIVE MEDICINE SERVICES

Table of content: (NPI 1194967778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194967778 NPI number — OCCUPATIONAL & PREVENTIVE MEDICINE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCCUPATIONAL & PREVENTIVE MEDICINE SERVICES
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:
1194967778
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16815 W 84TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LENEXA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66219-8057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-787-1423
Provider Business Mailing Address Fax Number:
913-322-1427

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 6TH AVE
Provider Second Line Business Practice Location Address:
MEDICAL ARTS BUILDING
Provider Business Practice Location Address City Name:
LEAVENWORTH
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66048-3225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-682-7225
Provider Business Practice Location Address Fax Number:
913-651-2007
Provider Enumeration Date:
03/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ZHAO
Authorized Official First Name:
CONG
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
913-787-1423

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  0431475 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QX0100X , with the licence number: 0431475 , 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)





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