1255433561 NPI number — DR. JAMESON FORSTER MD

Table of content: DR. JAMESON FORSTER MD (NPI 1255433561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255433561 NPI number — DR. JAMESON FORSTER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORSTER
Provider First Name:
JAMESON
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1255433561
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 E 104TH ST
Provider Second Line Business Mailing Address:
MAILSTOP 400
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-599-9499
Provider Business Mailing Address Fax Number:
816-932-9670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4320 WORNALL RD
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64111-5941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-932-4655
Provider Business Practice Location Address Fax Number:
816-932-7920
Provider Enumeration Date:
09/05/2006

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: 208600000X , with the licence number:  04-22921 , 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: 100115990A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 15364018 . This is a "BCBS KANSAS CITY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 202706107 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 625770 . This is a "FIRSTGUARD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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