1013175041 NPI number — DR CHARLES A KENDALL MD LLC

Table of content: (NPI 1013175041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013175041 NPI number — DR CHARLES A KENDALL MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR CHARLES A KENDALL MD 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:
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:
1013175041
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 785
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUE SPRINGS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64013-0785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-228-8768
Provider Business Mailing Address Fax Number:
816-228-8768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10010 E TRUMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64052-2160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-252-7800
Provider Business Practice Location Address Fax Number:
816-228-8768
Provider Enumeration Date:
05/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KENDALL
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
INTERNAL MEDICINE
Authorized Official Telephone Number:
816-252-7800

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  R2119 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 305R00000X , with the licence number: R2119 , 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: 40065013 . This is a "BCBS OF KANSAS CITY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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