1740855873 NPI number — TYLER CODY LORENZO HOUSER NP

Table of content: TYLER CODY LORENZO HOUSER NP (NPI 1740855873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740855873 NPI number — TYLER CODY LORENZO HOUSER NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOUSER
Provider First Name:
TYLER
Provider Middle Name:
CODY LORENZO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1740855873
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
930 CARONDELET DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64114-4698
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-943-5690
Provider Business Mailing Address Fax Number:
816-943-3156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 CAMBRIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66160-8501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-588-0900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2021

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: 163W00000X , with the licence number:  13135131121 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 2021029448 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: 2017025595 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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