1700895083 NPI number — DR. STEVEN C KOSA MD

Table of content: DR. STEVEN C KOSA MD (NPI 1700895083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700895083 NPI number — DR. STEVEN C KOSA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOSA
Provider First Name:
STEVEN
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1700895083
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2790 CLAY EDWARDS DR
Provider Second Line Business Mailing Address:
SUITE 1235
Provider Business Mailing Address City Name:
NORTH KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64116-3276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-472-5157
Provider Business Mailing Address Fax Number:
816-472-7201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2790 CLAY EDWARDS DR
Provider Second Line Business Practice Location Address:
SUITE 1235
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:
64116-3276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-472-5157
Provider Business Practice Location Address Fax Number:
816-472-7201
Provider Enumeration Date:
08/05/2006

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: 2084N0400X , with the licence number:  102605 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 48941 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 2009004527 , 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: 200613580B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 138690000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: ENROLLED , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 130001294 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1700895083 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200613580A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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