1245208206 NPI number — DR. ALEJANDRO BLACHAR M.D

Table of content: DR. ALEJANDRO BLACHAR M.D (NPI 1245208206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245208206 NPI number — DR. ALEJANDRO BLACHAR M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLACHAR
Provider First Name:
ALEJANDRO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
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:
1245208206
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4906 CREEK CROSSING DR
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:
64507-9683
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
802 N RIVERSIDE RD
Provider Second Line Business Practice Location Address:
STE 280
Provider Business Practice Location Address City Name:
SAINT JOSEPH
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64507-9794
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-271-6518
Provider Business Practice Location Address Fax Number:
816-271-6539
Provider Enumeration Date:
03/08/2006

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: 207LP2900X , with the licence number:  2001006090 , 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: 29673022 . This is a "BCBS KC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 455958 . This is a "PHP HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 10001091102 . This is a "CHP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1003955050A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 205272503 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29673012 . This is a "BCBS KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 5909146 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 7569516002 . This is a "CIGNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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