1073565149 NPI number — CHAD E HELMER PT

Table of content: CHAD E HELMER PT (NPI 1073565149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073565149 NPI number — CHAD E HELMER PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HELMER
Provider First Name:
CHAD
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1073565149
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17134 BEL RAY PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64012-5331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-226-4011
Provider Business Mailing Address Fax Number:
816-524-6115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1512 NE 96TH ST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
LIBERTY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64068-7174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-792-0775
Provider Business Practice Location Address Fax Number:
816-792-0776
Provider Enumeration Date:
05/17/2006

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: 225100000X , with the licence number:  112594 , 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: MA4370012 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 26735101 . This is a "BCBS KC" identifier . This identifiers is of the category "OTHER".