1336196971 NPI number — MIDWEST DIVISION - MCI, LLC

Table of content: (NPI 1336196971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336196971 NPI number — MIDWEST DIVISION - MCI, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST DIVISION - MCI, LLC
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:
MEDICAL CENTER OF INDEPENDENCE
Provider Other Organization Name Type Code:
3
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:
1336196971
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:
17203 E 23RD ST S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64057-1859
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-478-5000
Provider Business Mailing Address Fax Number:
816-836-6603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17203 E 23RD ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64057-1859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-478-5000
Provider Business Practice Location Address Fax Number:
816-836-6603
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DEHAVEN
Authorized Official First Name:
BRYCE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
816-836-6602

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 756700 . This is a "FAMILY HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 40917 . This is a "HEALTHCARE USA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 90039027 . This is a "BLUE CROSS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 1707066 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515790 . This is a "FIRST GUARD" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com