1588855894 NPI number — CHRISTOPHER TIMMER DCPA

Table of content: (NPI 1588855894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588855894 NPI number — CHRISTOPHER TIMMER DCPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTOPHER TIMMER DCPA
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:
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:
1588855894
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15203 W 87TH STREET PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LENEXA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66219-1409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-307-0150
Provider Business Mailing Address Fax Number:
913-599-1548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15203 W 87TH STREET PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENEXA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66219-1409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-307-0150
Provider Business Practice Location Address Fax Number:
913-599-1548
Provider Enumeration Date:
08/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TIMMER
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
913-307-0150

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 372575 . This is a "BCBS FOR STATE EMPLOYEES" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: P00182351 . This is a "RAILROAD MEDICARE #" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 28235029 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: N840000 . This is a "MEDICARE GROUP" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".