1285637058 NPI number — CITY OF EXCELSIOR SPRINGS

Table of content: (NPI 1285637058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285637058 NPI number — CITY OF EXCELSIOR SPRINGS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF EXCELSIOR SPRINGS
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:
6
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:
1285637058
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PADUCAH
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42002-9150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-744-9600
Provider Business Mailing Address Fax Number:
270-744-8642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 TRACY AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EXCELSIOR SPRINGS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64024-1141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-630-3000
Provider Business Practice Location Address Fax Number:
816-630-9530
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ST JOHN
Authorized Official First Name:
ZACHARY
Authorized Official Middle Name:
Authorized Official Title or Position:
ASST. CHIEF
Authorized Official Telephone Number:
816-630-3000

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  047074 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 800548307 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200266320A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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