1073887014 NPI number — KC PODIATRY CARE, PA

Table of content: (NPI 1073887014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073887014 NPI number — KC PODIATRY CARE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KC PODIATRY CARE, PA
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:
1073887014
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7301 MISSION RD
Provider Second Line Business Mailing Address:
SUITE 152
Provider Business Mailing Address City Name:
PRAIRIE VILLAGE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66208-3006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-432-2000
Provider Business Mailing Address Fax Number:
913-432-2001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7301 MISSION RD
Provider Second Line Business Practice Location Address:
SUITE 152
Provider Business Practice Location Address City Name:
PRAIRIE VILLAGE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66208-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-432-2000
Provider Business Practice Location Address Fax Number:
913-432-2001
Provider Enumeration Date:
03/07/2012

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
RAPHAEL
Authorized Official Middle Name:
NGUYEN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
913-432-2000

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  12-00309 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 114130 . This is a "MEDICARE PROVIDER GROUP # FOR KS (OUTSIDE KANSAS CITY LIMITS)" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 114130 . This is a "MEDICARE PIN FOR KS #" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: KA2540 . This is a "PTAN (FOR JOHNSON COUNTY AREA)" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 26580022 . This is a "BCBS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: KA2541 . This is a "PTAN (FOR OUTSIDE OF KANSAS CITY/JOHNSON CO AREAS)" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: S340000 . This is a "MEDICARE PROVIDER GROUP #" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: P00183110 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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