1609811819 NPI number — TIM BHAKTA, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609811819 NPI number — TIM BHAKTA, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIM BHAKTA, PA
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:
1609811819
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2875
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLATHE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66063-0875
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-397-6900
Provider Business Mailing Address Fax Number:
913-397-7999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 S CLAIRBORNE RD
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
OLATHE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66062-1735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-397-6900
Provider Business Practice Location Address Fax Number:
913-397-7999
Provider Enumeration Date:
06/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BHAKTA
Authorized Official First Name:
TIMIR
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
913-397-6900

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  0104981 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 36022028 . This is a "BLUE CROSS BLUE SHIELD KANSAS CITY" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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