1992725766 NPI number — CLINICAL COLLEAGUES INC

Table of content: (NPI 1992725766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992725766 NPI number — CLINICAL COLLEAGUES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICAL COLLEAGUES INC
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:
1992725766
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 824246
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19182-4246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-545-0337
Provider Business Mailing Address Fax Number:
954-545-3497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 E 23RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUTCHINSON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67502-1105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-494-3964
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZUMWALT
Authorized Official First Name:
KURT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
844-937-1810

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  UNKNOWN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 002514190 . This is a "MOUNTAIN STATE BLUE CROSS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 198604002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 62722573 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: DF9541 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 5902297 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 890960628A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 367500000X , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1992725766 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2741920 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: DD9442 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: DD9442 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0000111416 . This is a "BLUE CROSS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 3810018161 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200545920A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 610822000 . This is a "OWCP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 017H6 . This is a "BLUE CROSS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8000340 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: DF3380 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 0058WX . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 109341700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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