1003854589 NPI number — GO- MEDICAL SERVICES LLC

Table of content: (NPI 1003854589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003854589 NPI number — GO- MEDICAL SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GO- MEDICAL SERVICES LLC
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:
6
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:
1003854589
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 1923
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64055-0923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-358-8200
Provider Business Mailing Address Fax Number:
816-817-0028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10215 E US HIGHWAY 40
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64055-6147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-358-8200
Provider Business Practice Location Address Fax Number:
816-817-0028
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FELICIANO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
STANLEY
Authorized Official Title or Position:
PRESIDENT/MANAGING PARTNER
Authorized Official Telephone Number:
816-358-8200

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  00675817 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 35991012 . This is a "BCBS OF KANSAS CITY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 626221907 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200362040A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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