1285728527 NPI number — JEFFREY T ROITH D.P.M.

Table of content: JEFFREY T ROITH D.P.M. (NPI 1285728527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285728527 NPI number — JEFFREY T ROITH D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROITH
Provider First Name:
JEFFREY
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
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:
1285728527
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10550 QUIVIRA RD
Provider Second Line Business Mailing Address:
STE 360
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66215-2379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-894-4040
Provider Business Mailing Address Fax Number:
913-438-4725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10550 QUIVIRA RD
Provider Second Line Business Practice Location Address:
STE 360
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66215-2379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-894-4040
Provider Business Practice Location Address Fax Number:
913-438-4725
Provider Enumeration Date:
10/03/2006

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: 213E00000X , with the licence number:  000626 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 12-00235 , 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: 16317091 . This is a "BCBS KC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 490218 . This is a "BCBS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 16317081 . This is a "BCBS-KANSAS CITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 302968300 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com