1659749414 NPI number — REDISCOVER

Table of content: (NPI 1659749414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659749414 NPI number — REDISCOVER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REDISCOVER
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:
1659749414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1555 NE RICE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEES SUMMIT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64086-6034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-966-0900
Provider Business Mailing Address Fax Number:
816-347-3200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8800 BLUE RIDGE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-384-0700
Provider Business Practice Location Address Fax Number:
816-612-8756
Provider Enumeration Date:
09/10/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHASE
Authorized Official First Name:
STEWART
Authorized Official Middle Name:
A
Authorized Official Title or Position:
SENIOR VICE PRESIDENT
Authorized Official Telephone Number:
816-347-3243

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2800X , 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: 2228 . This is a "DEPT. OF MENTAL HEALTH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2396 . This is a "DEPT. OF MENTAL HEALTH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".