1225077522 NPI number — MRS. LORI BOYAJIAN-ONEILL D.O.

Table of content: MRS. LORI BOYAJIAN-ONEILL D.O. (NPI 1225077522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225077522 NPI number — MRS. LORI BOYAJIAN-ONEILL D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYAJIAN-ONEILL
Provider First Name:
LORI
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

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:
1225077522
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13003 WALMER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66209-3616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-915-9887
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6500 W 143RD 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:
66223-2174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-815-1861
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2006

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: 207QS0010X , with the licence number:  DO9N50 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 080135930 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200584170B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 243565322 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080135930 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1225077522 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200584170A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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