1265886972 NPI number — BROOKE MALENSEK PLPC

Table of content: BROOKE MALENSEK PLPC (NPI 1265886972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265886972 NPI number — BROOKE MALENSEK PLPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALENSEK
Provider First Name:
BROOKE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PLPC
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:
1265886972
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29114 E JUSTIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARWOOD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64750-9195
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-684-1956
Provider Business Mailing Address Fax Number:
417-667-7454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 S PREWITT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEVADA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64772-1760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-667-8700
Provider Business Practice Location Address Fax Number:
417-667-7454
Provider Enumeration Date:
04/19/2016

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: 101YP2500X , with the licence number:  2016007573 , 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: 1093043481 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1699756239 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com