1073624607 NPI number — COUNTY OF REPUBLIC

Table of content: (NPI 1073624607)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073624607 NPI number — COUNTY OF REPUBLIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF REPUBLIC
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:
1073624607
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2316 G ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVILLE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66935-2452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-527-5671
Provider Business Mailing Address Fax Number:
785-527-2892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2316 G ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVILLE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66935-2452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-527-5671
Provider Business Practice Location Address Fax Number:
785-527-2892
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SWANSON
Authorized Official First Name:
DANIELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
785-527-5671

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  A-079-001 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X , with the licence number: N/A ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100089410B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00658 . This is a "BCBS HOMEHEALTH" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 012767 . This is a "BCBS PUBLIC HEALTH" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100089410A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100071930A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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