1295824738 NPI number — JEFFREY T MACMILLAN MD PA

Table of content: (NPI 1295824738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295824738 NPI number — JEFFREY T MACMILLAN MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFREY T MACMILLAN MD PA
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:
1295824738
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9119 W 74TH ST
Provider Second Line Business Mailing Address:
SUITE 354
Provider Business Mailing Address City Name:
MERRIAM
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66204-2215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-894-2121
Provider Business Mailing Address Fax Number:
913-894-9592

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12200 W 106TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66215-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-894-2121
Provider Business Practice Location Address Fax Number:
913-894-9592
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MACMILLAN
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
913-894-2121

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  04-25519 , 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: DG2851 . This is a "RR MEDICARE GROUP #" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100171940A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21793020 . This is a "BCBS KC" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 200030413 . This is a "MEDICARE RR" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 208162701 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com