1316257058 NPI number — AFFINITY BIOTECH, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316257058 NPI number — AFFINITY BIOTECH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AFFINITY BIOTECH, INC.
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:
1316257058
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 E 101ST TER
Provider Second Line Business Mailing Address:
STE. 240
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64131-3367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-994-3652
Provider Business Mailing Address Fax Number:
816-994-2551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11303 CHIMNEY ROCK RD
Provider Second Line Business Practice Location Address:
STE. 105
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77035-2901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-551-2087
Provider Business Practice Location Address Fax Number:
888-805-3450
Provider Enumeration Date:
10/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
O'NEILL
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
816-994-3652

Provider Taxonomy Codes

  • Taxonomy code: 3336H0001X , with the licence number:  26845 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1063748812 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4555299 . This is a "NCPDP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 146147 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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