1770596512 NPI number — DR. STEVEN M PASSMAN M.D.

Table of content: DR. STEVEN M PASSMAN M.D. (NPI 1770596512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770596512 NPI number — DR. STEVEN M PASSMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PASSMAN
Provider First Name:
STEVEN
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1770596512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1861 N ROCK RD
Provider Second Line Business Mailing Address:
SUITE 310
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67206-4200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-612-1833
Provider Business Mailing Address Fax Number:
316-612-2420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1861 N ROCK RD
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67206-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-612-1833
Provider Business Practice Location Address Fax Number:
316-612-2420
Provider Enumeration Date:
08/14/2006

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: 207NS0135X , with the licence number:  04-20338 , 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)

  • Identifier: 102832 . This is a "PREMIER BLUE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 110898 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 412085867-A002 . This is a "TRICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: P00058828 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 611580 . This is a "FIRST GUARD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com