1376515080 NPI number — DEBRA A ATKINSON MD

Table of content: DEBRA A ATKINSON MD (NPI 1376515080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376515080 NPI number — DEBRA A ATKINSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ATKINSON
Provider First Name:
DEBRA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CADA
Provider Other First Name:
DEBRA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376515080
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
67 SILVER CREEK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELDON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65026-5430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-280-0672
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1870 BAGNELL DAM BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE OZARK
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65049-8658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-365-2318
Provider Business Practice Location Address Fax Number:
573-365-3009
Provider Enumeration Date:
02/06/2006

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: 207Q00000X , with the licence number:  2000162958 , 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)

  • Identifier: 130110 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 937875 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 205061104 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: MA4964061 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 080165723 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3156281 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 438746 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 440546366 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: G25024 . This is a "MERCY" identifier . This identifiers is of the category "OTHER".




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