1275708257 NPI number — MS. IRIS MELANY TAN OTR/L

Table of content: LAURA LEA LOMAX M.D. (NPI 1659340313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275708257 NPI number — MS. IRIS MELANY TAN OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAN
Provider First Name:
IRIS
Provider Middle Name:
MELANY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TAN
Provider Other First Name:
IRIS MELANY
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1275708257
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 NE 103RD ST
Provider Second Line Business Mailing Address:
APT 5E
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64155-3045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-590-9120
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 NE 103RD ST
Provider Second Line Business Practice Location Address:
APT 5E
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64155-3045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-590-9120
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2008

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: 225X00000X , with the licence number:  2007019336 , 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)