1336281534 NPI number — DR. J.A. DIRENNA JR, P.C.

Table of content: (NPI 1336281534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336281534 NPI number — DR. J.A. DIRENNA JR, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. J.A. DIRENNA JR, P.C.
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:
1336281534
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2181
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64055-0081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-248-9693
Provider Business Mailing Address Fax Number:
913-248-9383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 THE WOODLANDS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLADSTONE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64119-1853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-225-1643
Provider Business Practice Location Address Fax Number:
913-248-9383
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DIRENNA
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
816-225-1643

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  R6C32 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 19739014 . This is a "BLUE SHIELD KC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com