1104882414 NPI number — BARBARA A. BROWN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104882414 NPI number — BARBARA A. BROWN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARBARA A. BROWN
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:
1104882414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
128 S 5TH ST
Provider Second Line Business Mailing Address:
PO BOX 307
Provider Business Mailing Address City Name:
OSBORNE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67473-2304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-346-2033
Provider Business Mailing Address Fax Number:
785-346-2919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
128 S 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSBORNE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67473-2304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-346-2033
Provider Business Practice Location Address Fax Number:
785-346-2919
Provider Enumeration Date:
04/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN APPLEGATE
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
785-346-2033

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0523287 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: 1500690 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100359250A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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