1225075070 NPI number — PODIATRY ASSOCIATES, PA

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 1225075070 NPI number — PODIATRY ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PODIATRY 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:
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:
1225075070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8901 W 74TH ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SHAWNEE MISSION
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66204-2204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-432-5052
Provider Business Mailing Address Fax Number:
913-432-9990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8901 W 74TH ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SHAWNEE MISSION
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66204-2204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-432-5052
Provider Business Practice Location Address Fax Number:
913-432-9990
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TROESTER
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
913-226-9178

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: B360000D . This is a "MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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