1508898883 NPI number — DR. JEFFREY W. WOOD DC FIACA

Table of content: (NPI 1861406498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508898883 NPI number — DR. JEFFREY W. WOOD DC FIACA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOD
Provider First Name:
JEFFREY
Provider Middle Name:
W.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC FIACA
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:
1508898883
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
426 N A ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARKANSAS CITY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67005-2208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-442-8900
Provider Business Mailing Address Fax Number:
620-442-8927

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
426 N A ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARKANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67005-2208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-442-8900
Provider Business Practice Location Address Fax Number:
620-442-8927
Provider Enumeration Date:
07/07/2006

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: 111N00000X , with the licence number:  01-04065 , 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)

  • Identifier: 660023 . This is a "MEDICARE/ PTAN/ BCBS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: DA1482 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 060917 . This is a "KS BCBS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 226490 . This is a "COVENTRY INSURANCE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 2122 . This is a "PREFERRED PLUS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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