1467498329 NPI number — JOHN H STANLEY M.D.LLC

Table of content: (NPI 1467498329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467498329 NPI number — JOHN H STANLEY M.D.LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN H STANLEY M.D.LLC
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:
JOHN H STANLEY M.D.
Provider Other Organization Name Type Code:
4
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:
1467498329
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8080 WARD PARKWAY
Provider Second Line Business Mailing Address:
SUITE 113
Provider Business Mailing Address City Name:
KANSAS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64114-2020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-561-2533
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8080 WARD PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 113
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64114-2020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-561-2533
Provider Business Practice Location Address Fax Number:
815-444-5044
Provider Enumeration Date:
06/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STANLEY MD LLC
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
816-561-2533

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  R3850 , 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: 200763027 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com