1154512978 NPI number — ALFRED GILGORE MEDICAL ASSOCIATES PA

Table of content: (NPI 1154512978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154512978 NPI number — ALFRED GILGORE MEDICAL ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALFRED GILGORE MEDICAL ASSOCIATES 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:
1154512978
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9421 PFLUMM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LENEXA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66215-3307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-888-1133
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9421 PFLUMM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENEXA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66215-3307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-888-1133
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GILGORE
Authorized Official First Name:
ALFRED
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN/PRESIDENT
Authorized Official Telephone Number:
913-888-1133

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  15547 , 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: 5370000A . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 03952017 . This is a "BCBSKC" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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