1205016979 NPI number — COMPREHENSIVE FOOT CENTERS P.A.

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 1205016979 NPI number — COMPREHENSIVE FOOT CENTERS P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE FOOT CENTERS P.A.
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:
1205016979
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 RUSH CREEK PKWY
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
LIBERTY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64068-9604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-455-1155
Provider Business Mailing Address Fax Number:
816-455-1161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11413 ASH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66211-1682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-455-1155
Provider Business Practice Location Address Fax Number:
816-455-1161
Provider Enumeration Date:
11/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
RISHONA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
816-455-1155

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  12-00227 , 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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