1659370161 NPI number — CHRISTA RUBLE BALANOFF M.D.

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 1659370161 NPI number — CHRISTA RUBLE BALANOFF M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALANOFF
Provider First Name:
CHRISTA
Provider Middle Name:
RUBLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RUBLE
Provider Other First Name:
CHRISTA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659370161
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10787 NALL AVE
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66211-1375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-945-9400
Provider Business Mailing Address Fax Number:
913-945-9410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10787 NALL AVE
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66211-1375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-945-9400
Provider Business Practice Location Address Fax Number:
913-945-9410
Provider Enumeration Date:
07/18/2005

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: 208600000X , with the licence number:  04-31985 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: 2006018662 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200195500 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1009224 . This is a "TRICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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