1093170748 NPI number — JAMES WAYNE FOX BAS, T-LAC, PCCM,

Table of content: JAMES WAYNE FOX BAS, T-LAC, PCCM, (NPI 1093170748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093170748 NPI number — JAMES WAYNE FOX BAS, T-LAC, PCCM,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOX
Provider First Name:
JAMES
Provider Middle Name:
WAYNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BAS, T-LAC, PCCM,
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:
1093170748
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4015 SW 21ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOPEKA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66604-3412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-266-0202
Provider Business Mailing Address Fax Number:
785-267-3439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4015 SE 21 ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-266-0202
Provider Business Practice Location Address Fax Number:
786-267-3439
Provider Enumeration Date:
12/23/2015

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: 101YA0400X , with the licence number:  T-LAC 1361 , 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)





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