1407846454 NPI number — CHERYL L GAINES CRNA

Table of content: CHERYL L GAINES CRNA (NPI 1407846454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407846454 NPI number — CHERYL L GAINES CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAINES
Provider First Name:
CHERYL
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1407846454
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 SWIFT AVE
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
NORTH KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64116-3445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-221-5050
Provider Business Mailing Address Fax Number:
816-471-1247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 CLAY EDWARDS DR
Provider Second Line Business Practice Location Address:
ANESTHESIA DEPT
Provider Business Practice Location Address City Name:
NORTH KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64116-3220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-221-5050
Provider Business Practice Location Address Fax Number:
816-471-1247
Provider Enumeration Date:
10/21/2005

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: 367500000X , with the licence number:  2010021175 , 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: P00937035 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 304382700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 430027986 . This is a "MCRR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: G1400 . This is a "BSFL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: G1400Z . This is a "MCR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: H900000016 . This is a "MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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