1275291890 NPI number — LITTLE APPLE PODIATRY, LLC

Table of content: (NPI 1275291890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275291890 NPI number — LITTLE APPLE PODIATRY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LITTLE APPLE PODIATRY, LLC
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:
1275291890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
711 WHITETAIL PASS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANHATTAN
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66503-2598
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-461-0532
Provider Business Mailing Address Fax Number:
785-320-2066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1133 COLLEGE AVE STE A211
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502-2751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-775-0050
Provider Business Practice Location Address Fax Number:
785-576-2580
Provider Enumeration Date:
12/01/2021

Additional Information

Authorized Official

Authorized Official Last Name:
COSENTINO
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
ROSE
Authorized Official Title or Position:
CEO/EMPLOYEE
Authorized Official Telephone Number:
785-775-0050

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1200458 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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