1558363838 NPI number — CARONDELET EMERGENCY PHYSICIANS INC

Table of content: (NPI 1558363838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558363838 NPI number — CARONDELET EMERGENCY PHYSICIANS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARONDELET EMERGENCY PHYSICIANS INC
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:
ST JOSEPHS EMERGENCY PHYSICIANS INC
Provider Other Organization Name Type Code:
4
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:
1558363838
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11347
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTONA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32120-1347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-274-7800
Provider Business Mailing Address Fax Number:
386-274-7801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 CARONDELET DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64114-4673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-942-4400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GREENWOOD
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDNET
Authorized Official Telephone Number:
816-942-4400

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  MD100341 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 140684700 . This is a "ST JOSEPH'S FEDERAL WC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 13247011 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 506972405 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: CU0181 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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