1356330427 NPI number — DR. RICHARD CRONEMEYER

Table of content: DR. RICHARD CRONEMEYER (NPI 1356330427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356330427 NPI number — DR. RICHARD CRONEMEYER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRONEMEYER
Provider First Name:
RICHARD
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
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:
1356330427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5800 FOXRIDGE DR
Provider Second Line Business Mailing Address:
SUITE 240
Provider Business Mailing Address City Name:
MISSION
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66202-2347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-261-3153
Provider Business Mailing Address Fax Number:
913-262-3295

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5800 FOXRIDGE DR
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
MISSION
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66202-2347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-261-3153
Provider Business Practice Location Address Fax Number:
913-262-3295
Provider Enumeration Date:
10/20/2005

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: 2085R0202X , with the licence number:  R9887 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 04-07808 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100153490F , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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