1528074499 NPI number — SHAWNEE COUNTY (MEDICAID PART C)

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528074499 NPI number — SHAWNEE COUNTY (MEDICAID PART C)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHAWNEE COUNTY (MEDICAID PART C)
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:
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:
1528074499
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 SW EAST CIRCLE DR S
Provider Second Line Business Mailing Address:
SHAWNEE COUNTY (MEDICAID PART C)
Provider Business Mailing Address City Name:
TOPEKA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66606-2447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-251-5600
Provider Business Mailing Address Fax Number:
785-251-5696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 SW EAST CIRCLE DR S
Provider Second Line Business Practice Location Address:
SHAWNEE COUNTY (MEDICAID PART C)
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66606-2447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-251-5600
Provider Business Practice Location Address Fax Number:
785-251-5696
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GAINES
Authorized Official First Name:
EDITH
Authorized Official Middle Name:
J
Authorized Official Title or Position:
FINANCE OFFICER
Authorized Official Telephone Number:
785-251-5666

Provider Taxonomy Codes

  • Taxonomy code: 261QP0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100089380A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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