1689605636 NPI number — WILLIAM FREDERICK SHONKWILER PT

Table of content: WILLIAM FREDERICK SHONKWILER PT (NPI 1689605636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689605636 NPI number — WILLIAM FREDERICK SHONKWILER PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHONKWILER
Provider First Name:
WILLIAM
Provider Middle Name:
FREDERICK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

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:
1689605636
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3497
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STURTEVANT
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53177-0300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-552-2996
Provider Business Mailing Address Fax Number:
866-245-8064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1311 N. BELT HWY
Provider Second Line Business Practice Location Address:
SUITE A & B
Provider Business Practice Location Address City Name:
SAINT JOSEPH
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-279-7778
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2006

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: 225100000X , with the licence number:  2002011893 , 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: 650024543 . This is a "RR MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: P00600064 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 10001688300 . This is a "COMMUNITY HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 487421505 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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