1760621924 NPI number — ACTIVE FOOT SOLUTIONS PA

Table of content: (NPI 1760621924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760621924 NPI number — ACTIVE FOOT SOLUTIONS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACTIVE FOOT SOLUTIONS PA
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:
AMBER S. BEISIEGEL, D.P.M.
Provider Other Organization Name Type Code:
3
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:
1760621924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10318 WALMER ST
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:
66212-1741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-649-6677
Provider Business Mailing Address Fax Number:
913-649-6679

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10464 METCALF AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66212-1806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-649-6677
Provider Business Practice Location Address Fax Number:
913-649-6679
Provider Enumeration Date:
02/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BEISIEGEL
Authorized Official First Name:
AMBER
Authorized Official Middle Name:
STEINFORD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
913-649-6677

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X , with the licence number:  12-00313 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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