1396749636 NPI number — DIANE S VOSS MD

Table of content: DIANE S VOSS MD (NPI 1396749636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396749636 NPI number — DIANE S VOSS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VOSS
Provider First Name:
DIANE
Provider Middle Name:
S
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:
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:
1396749636
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17331 E US HIGHWAY 40
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64055-5364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-272-4877
Provider Business Mailing Address Fax Number:
816-272-4977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17331 E US HIGHWAY 40
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64055-5364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-272-4877
Provider Business Practice Location Address Fax Number:
816-272-4977
Provider Enumeration Date:
06/01/2005

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: 207R00000X , with the licence number:  101659 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208D00000X , with the licence number: 101659 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1396749636 . This is a "COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1009426 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1014980 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1396749636 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18433101 . This is a "BCBS OF KANSAS CITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1396749606 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1610652 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 203420112 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00455253 . This is a "RAILROAD MEDIARE" identifier . This identifiers is of the category "OTHER".




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