1245546266 NPI number — MRS. REBECCA DIANE LOOMIS P.A.

Table of content: MRS. REBECCA DIANE LOOMIS P.A. (NPI 1245546266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245546266 NPI number — MRS. REBECCA DIANE LOOMIS P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOOMIS
Provider First Name:
REBECCA
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHITE
Provider Other First Name:
REBECCA
Provider Other Middle Name:
DIANE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245546266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 S SANTA FE AVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
SALINA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-823-1032
Provider Business Mailing Address Fax Number:
785-452-7807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 S SANTA FE AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
SALINA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-823-1032
Provider Business Practice Location Address Fax Number:
785-452-7807
Provider Enumeration Date:
08/27/2010

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: 363AM0700X , with the licence number:  15-01395 , 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: 200674440B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200674440A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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