1396952990 NPI number — BRIAN K. HAITH DPM PA

Table of content: (NPI 1396952990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396952990 NPI number — BRIAN K. HAITH DPM PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIAN K. HAITH DPM PA
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:
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:
1396952990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4225 W. 107TH ST. #7310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-648-7440
Provider Business Mailing Address Fax Number:
913-648-7440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4319 W 111TH TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEAWOOD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66211-1701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-648-7440
Provider Business Practice Location Address Fax Number:
913-648-7440
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAITH
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
913-648-7440

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DD3689 . This is a "RRPTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P22357013 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 504447202 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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