1780784645 NPI number — DR. GREGORY D NANNEY MD

Table of content: DR. GREGORY D NANNEY MD (NPI 1780784645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780784645 NPI number — DR. GREGORY D NANNEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NANNEY
Provider First Name:
GREGORY
Provider Middle Name:
D
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:
1780784645
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2021
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:
SALINA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67402-0256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-823-0633
Provider Business Mailing Address Fax Number:
785-823-0658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
730 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67114-8778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-283-1141
Provider Business Practice Location Address Fax Number:
316-283-1162
Provider Enumeration Date:
09/22/2006

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: 207RH0003X , with the licence number:  2010033317 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 04-21354 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RX0202X , with the licence number: 04-21354 , 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: 1780784645 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200430590A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 146240008 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 100133900G , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100133900F , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016701012 . This is a "MEDICARE PTAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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