1285131839 NPI number — BRIAN ALAN WARDEN

Table of content: BRIAN ALAN WARDEN (NPI 1285131839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285131839 NPI number — BRIAN ALAN WARDEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARDEN
Provider First Name:
BRIAN
Provider Middle Name:
ALAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1285131839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1020 SANSOM ST STE 1651B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19107-5002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-955-9837
Provider Business Mailing Address Fax Number:
215-995-9870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8929 PARALLEL PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66112-1689
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-596-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2018

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: 207P00000X , with the licence number:  148960 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 04-46743 , 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)

  • Identifier: 111115200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".