1346337516 NPI number — JOHN KNOX VILLAGE

Table of content: (NPI 1346337516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346337516 NPI number — JOHN KNOX VILLAGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN KNOX VILLAGE
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:
1346337516
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 NW MURRAY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEES SUMMIT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64081-1426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 NW PRYOR RD UNIT 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEES SUMMIT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64081-1104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-525-0986
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COLUMBATTO
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
Authorized Official Title or Position:
VP HEALTH SERVICES
Authorized Official Telephone Number:
816-347-2030

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  115-4HO , 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: 821070802 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com