1568402394 NPI number — DR. LYNN L MCINTOSH D.C.

Table of content: DR. LYNN L MCINTOSH D.C. (NPI 1568402394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568402394 NPI number — DR. LYNN L MCINTOSH D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCINTOSH
Provider First Name:
LYNN
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

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:
1568402394
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3738 HARRISON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64109-2648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-931-7689
Provider Business Mailing Address Fax Number:
816-753-4620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4700 BELLEVIEW AVE
Provider Second Line Business Practice Location Address:
SUITE L12
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64112-1378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-753-4600
Provider Business Practice Location Address Fax Number:
816-753-4620
Provider Enumeration Date:
06/08/2006

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: 111NS0005X , with the licence number:  2002030424 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111NS0005X , with the licence number: 01-04816 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 32542012 . This is a "BLUE CROSS BLUE SHIELD ID" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 85-0487961 . This is a "TAX ID" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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