1578672135 NPI number — DR. JOHN STEVEN JARSTAD M.D.

Table of content: (NPI 1124249172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578672135 NPI number — DR. JOHN STEVEN JARSTAD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JARSTAD
Provider First Name:
JOHN
Provider Middle Name:
STEVEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1578672135
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 843966
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:
64184-3966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-884-3300
Provider Business Mailing Address Fax Number:
573-884-0943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65212-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-882-1506
Provider Business Practice Location Address Fax Number:
573-884-5575
Provider Enumeration Date:
08/29/2006

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: 207W00000X , with the licence number:  MD00026367 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 2015030665 , 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: 9116JA . This is a "REGENCE AUBURN RYDER #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: EV8144 . This is a "REGENCE GROUP NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 59460 . This is a "L&I GROUP NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2147JA . This is a "REGENCE BURIEN RYDER #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7080781 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 91162803298116A002 . This is a "TRICARE/WPS BURIEN #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 91162803298002A002 . This is a "TRICARE & WPS AUBURN #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0870427 . This is a "AETNA GROUP NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 891451 . This is a "CRIME VICTIMS GROUP #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8914516 . This is a "CRIME VICTIMS INDIVIDUAL" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 91162803298003A002 . This is a "TRICARE/WPS FED WAY #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 180017371 . This is a "RAILROAD MEDICARE IND #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8120586 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 911628032 . This is a "BLUE CROSS PREMERA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: JA8144 . This is a "REGENCE FEDERAL WAY RYDER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 59459 . This is a "L&I INDIVIDUAL NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 104632100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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