1245434653 NPI number — DR W THOMAS NORMAN DDS P C

Table of content: (NPI 1245434653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245434653 NPI number — DR W THOMAS NORMAN DDS P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR W THOMAS NORMAN DDS P C
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:
6
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:
1245434653
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1212 SW LUTTRELL RD STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUE SPRINGS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64015-4912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-229-7267
Provider Business Mailing Address Fax Number:
816-224-8402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1212 SW LUTTRELL RD STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUE SPRINGS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64015-4912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-229-7267
Provider Business Practice Location Address Fax Number:
816-224-8402
Provider Enumeration Date:
06/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NORMAN
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
816-229-7267

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 06948015 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 064954 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 197232 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com