1083802664 NPI number — DR. ROBERT W WARNER DC PA

Table of content: DR. ROBERT W WARNER DC PA (NPI 1083802664)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083802664 NPI number — DR. ROBERT W WARNER DC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARNER
Provider First Name:
ROBERT
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC PA
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:
1083802664
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2112 BOB BILLINGS PKWY
Provider Second Line Business Mailing Address:
STE 1
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66049-2722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-843-3033
Provider Business Mailing Address Fax Number:
785-843-3127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2112 BOB BILLINGS PKWY
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66049-2722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-843-3033
Provider Business Practice Location Address Fax Number:
785-843-3127
Provider Enumeration Date:
10/09/2007

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: 111N00000X , with the licence number:  01-03798 , 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: 350011416 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 37371 . This is a "PREFERRED HEALTH PROFESSI" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 5305636 . This is a "AETNA" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 062466 . This is a "BLUE CROSS BLUE SHIELD KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 007359 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 10881944 . This is a "CAQH CREDENTIALING DATA" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 160522 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 2385019 . This is a "BLUE CROSS OF KANSAS CITY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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