1396851762 NPI number — FOUR B CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396851762 NPI number — FOUR B CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOUR B CORP
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:
Provider Other Organization Name Type Code:
6
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:
1396851762
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5300 SPEAKER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66106-1050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-573-1294
Provider Business Mailing Address Fax Number:
913-551-8580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2774 W 53RD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRWAY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-236-4983
Provider Business Practice Location Address Fax Number:
913-677-1867
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ARENSON
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
Authorized Official Title or Position:
3RD PARTY ADMIN.
Authorized Official Telephone Number:
913-573-1294

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 2-10011 , 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: 2027344 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100439440F , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100439440E , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com