1215981691 NPI number — WILLIAM N BRODINE MD

Table of content: WILLIAM N BRODINE MD (NPI 1215981691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215981691 NPI number — WILLIAM N BRODINE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRODINE
Provider First Name:
WILLIAM
Provider Middle Name:
N
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:
1215981691
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 872332
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:
64187-2332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-525-1600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 NE RALPH POWELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEES SUMMIT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64064-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-525-1600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/20/2006

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: 207RC0001X , with the licence number:  R3E15 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0001X , with the licence number: 0419969 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 10071014 . This is a "PHP FREEDOM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431092652 A020 . This is a "CHAMPUS TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10071014 . This is a "BLUE SHIELD OF KC PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1215981691 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10071014 . This is a "BLUE SHIELD OF KC HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0004626639 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060013888 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0004626639 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0004626639 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".




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