1902916430 NPI number — DR. BARRY FRANK KURZ LCSW

Table of content: DR. BARRY FRANK KURZ LCSW (NPI 1902916430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902916430 NPI number — DR. BARRY FRANK KURZ LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KURZ
Provider First Name:
BARRY
Provider Middle Name:
FRANK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1902916430
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7802 N UNIVERSITY
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61614-8302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-693-0111
Provider Business Mailing Address Fax Number:
309-693-0112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7802 N UNIVERSITY
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61614-8302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-693-0111
Provider Business Practice Location Address Fax Number:
309-693-0112
Provider Enumeration Date:
08/30/2006

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: 104100000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0007271403 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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