1538533443 NPI number — COTTONWOOD SPRINGS PHYSICIAN GROUP LLC

Table of content: MRS. MICHELLE LYN VENEMAN R.N., CNP (NPI 1932532231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538533443 NPI number — COTTONWOOD SPRINGS PHYSICIAN GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COTTONWOOD SPRINGS PHYSICIAN GROUP 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:
Provider Other Organization Name Type Code:
6
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:
1538533443
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 HAZEL LN STE 305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEWICKLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15143-1249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-588-3546
Provider Business Mailing Address Fax Number:
412-710-7068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13351 S ARAPAHO DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLATHE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66062-1520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-353-3000
Provider Business Practice Location Address Fax Number:
913-353-3001
Provider Enumeration Date:
11/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DELANEY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
913-353-3000

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 201146370A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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