1265578751 NPI number — DR. ARMISA TONGSON CULLENS M.D.

Table of content: DR. ARMISA TONGSON CULLENS M.D. (NPI 1265578751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265578751 NPI number — DR. ARMISA TONGSON CULLENS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CULLENS
Provider First Name:
ARMISA
Provider Middle Name:
TONGSON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TONGSON
Provider Other First Name:
ARMISA
Provider Other Middle Name:
CULANCULAN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265578751
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14811 W 81ST PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LENEXA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66215-4292
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-941-0440
Provider Business Mailing Address Fax Number:
816-941-9966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
930 CARONDELET DR
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64114-4855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-941-0440
Provider Business Practice Location Address Fax Number:
816-941-9966
Provider Enumeration Date:
01/30/2007

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: 208000000X , with the licence number:  R1J85 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 0422532 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2050070802 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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