1699774893 NPI number — GATES HOSPITALISTS LLC

Table of content: (NPI 1699774893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699774893 NPI number — GATES HOSPITALISTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GATES HOSPITALISTS LLC
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:
1699774893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 256
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIBERTY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64069-0256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-968-9320
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2750 CLAY EDWARDS DR STE 200A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64116-3237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-968-9320
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GATES
Authorized Official First Name:
STACEY
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
816-968-9320

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  2000174342 , 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: 509340907 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200305270A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33624016 . This is a "BLUE SHIELD KANSAS CITY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".