1679873046 NPI number — KEN KIDD INC DBA MIRACLE-EAR

Table of content: DR. ARTHUR DOUGLAS JOHNSON DDS (NPI 1861441503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679873046 NPI number — KEN KIDD INC DBA MIRACLE-EAR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEN KIDD INC DBA MIRACLE-EAR
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:
1679873046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7410 W 119TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-498-0909
Provider Business Mailing Address Fax Number:
816-942-4302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1148 W. 103RD ST
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:
64114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-942-4300
Provider Business Practice Location Address Fax Number:
816-942-4302
Provider Enumeration Date:
11/01/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KIDD
Authorized Official First Name:
KENNTETH
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
913-498-0909

Provider Taxonomy Codes

  • Taxonomy code: 237700000X , with the licence number:  2007008453 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 237700000X , with the licence number: 1345 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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