1447281357 NPI number — MR. JOHN H KOPPENHAVER IV MA, LCP

Table of content: MR. JOHN H KOPPENHAVER IV MA, LCP (NPI 1447281357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447281357 NPI number — MR. JOHN H KOPPENHAVER IV MA, LCP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOPPENHAVER
Provider First Name:
JOHN
Provider Middle Name:
H
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
IV
Provider Credential Text:
MA, LCP
Provider Gender Code:
M

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:
1447281357
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
227 N EDGEMOOR ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67208-4420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-684-3688
Provider Business Mailing Address Fax Number:
316-684-7249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 W IRA CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANDOVER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67002-9469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-733-5047
Provider Business Practice Location Address Fax Number:
316-733-5060
Provider Enumeration Date:
07/06/2006

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: 103T00000X , with the licence number:  LCP 248 , 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)