1316959091 NPI number — EDWARD J. LAUGHLIN MD

Table of content: EDWARD J. LAUGHLIN MD (NPI 1316959091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316959091 NPI number — EDWARD J. LAUGHLIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAUGHLIN
Provider First Name:
EDWARD
Provider Middle Name:
J.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1316959091
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5501 NW 62ND TER
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64151-2408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-584-8884
Provider Business Mailing Address Fax Number:
913-945-9612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10787 NALL AVE.
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66211-1372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-588-9400
Provider Business Practice Location Address Fax Number:
913-588-9450
Provider Enumeration Date:
08/12/2006

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: 207RC0000X , with the licence number:  R6F84 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 04-26656 , 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: 100328390A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12427043 . This is a "BCBS KC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 100328390B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051554 . This is a "BCBS KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 208516310 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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