1538127642 NPI number — CENTRAL PLAINS RADIOLOGIC SERVICES PA

Table of content: (NPI 1538127642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538127642 NPI number — CENTRAL PLAINS RADIOLOGIC SERVICES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL PLAINS RADIOLOGIC SERVICES PA
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:
CHENEY HEALTH CENTER GOULD CHIROPRACTIC
Provider Other Organization Name Type Code:
5
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:
1538127642
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
126 N MAIN
Provider Second Line Business Mailing Address:
PO BOX 190
Provider Business Mailing Address City Name:
CHENEY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-542-3400
Provider Business Mailing Address Fax Number:
316-542-0584

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 N MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHENEY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-542-3400
Provider Business Practice Location Address Fax Number:
316-542-0584
Provider Enumeration Date:
05/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOULD
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO CENTRAL PLAINS RADIOLOGIC SERV
Authorized Official Telephone Number:
316-542-3400

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3953 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 111NR0200X , with the licence number: 3953 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 111NR0200X , with the licence number: 3111 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 060997 . This is a "BCBS RADIO GROUP #660046" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 060952 . This is a "BCBS CHIRO PROVIDER #" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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