1902871353 NPI number — DR. JOHN T GROWNEY MD

Table of content: DR. JOHN T GROWNEY MD (NPI 1902871353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902871353 NPI number — DR. JOHN T GROWNEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROWNEY
Provider First Name:
JOHN
Provider Middle Name:
T
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:
GROWNEY
Provider Other First Name:
JOHN
Provider Other Middle Name:
T
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902871353
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 ATCHISON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATCHISON
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66002-2352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-367-5020
Provider Business Mailing Address Fax Number:
913-367-1089

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 ATCHISON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATCHISON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66002-2352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-367-5020
Provider Business Practice Location Address Fax Number:
913-367-1089
Provider Enumeration Date:
02/21/2006

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: 207Q00000X , with the licence number:  04-15196 , 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: 46144861 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 460484 . This is a "CHILDRENS MERCY FAMILY HEALTH PARTNERS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 6365 . This is a "UNICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 0188344 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: KS0600409 . This is a "TRIWEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100087100A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106418 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 011077482 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 05635019 . This is a "BLUE CROSS BLUE SHIELD OF KANSAS CITY INDIVIDUAL NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 111327 . This is a "BLUE CROSS BLUE SHIELD OF KANSAS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 106418 . This is a "BLUE CROSS BLUE SHIELD OF KANSAS GROUP NUMBER" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 05634011 . This is a "BLUE CROSS BLUE SHIELD OF KANSAS CITY GROUP NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 10001214400 . This is a "COMMUNITY HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 132942 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".




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