1235300344 NPI number — JOHN B. STURGEON M.D. P.A.

Table of content: (NPI 1235300344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235300344 NPI number — JOHN B. STURGEON M.D. P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN B. STURGEON M.D. 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:
1235300344
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 803855
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64180-3855
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-234-1350
Provider Business Mailing Address Fax Number:
913-234-1108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8800 W 75TH ST
Provider Second Line Business Practice Location Address:
STE 310
Provider Business Practice Location Address City Name:
SHAWNEE MISSION
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66204-2205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-671-7803
Provider Business Practice Location Address Fax Number:
913-722-0012
Provider Enumeration Date:
03/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
STURGEON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
913-234-1350

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  0423283 , 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: DN2011 . This is a "RR MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 40286019 . This is a "BCBS OF KCMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 424345 . This is a "BCBS OF KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100159950B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100514 . This is a "BCBS OF GARNETT KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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