1467863910 NPI number — MRS. MICHELLE PARTRIDGE COTA

Table of content: MRS. MICHELLE PARTRIDGE COTA (NPI 1467863910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467863910 NPI number — MRS. MICHELLE PARTRIDGE COTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARTRIDGE
Provider First Name:
MICHELLE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
COTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BUDREAU
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467863910
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/14/2018
NPI Reactivation Date:
03/26/2019

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BUILDING 2200, 3500 N. ROCK RD. #101
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:
67226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-440-3316
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 S WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67152-3037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-326-4300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2014

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: 224Z00000X , with the licence number:  18-00962 , 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)





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