1881054005 NPI number — BLUESTEM PACE

Table of content: (NPI 1881054005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881054005 NPI number — BLUESTEM PACE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLUESTEM PACE
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:
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:
1881054005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 IVY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH NEWTON
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67117-8001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-836-4800
Provider Business Mailing Address Fax Number:
316-836-4250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 S ASH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCPHERSON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67460-4801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-504-5900
Provider Business Practice Location Address Fax Number:
620-504-5674
Provider Enumeration Date:
03/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
620-504-5950

Provider Taxonomy Codes

  • Taxonomy code: 251T00000X , with the licence number:  H9438 , 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: H9438 . This is a "PACE PLAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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