1366574832 NPI number — DR. BENJAMIN ALBERT HENSLEY JR. D.O.

Table of content: DR. BENJAMIN ALBERT HENSLEY JR. D.O. (NPI 1366574832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366574832 NPI number — DR. BENJAMIN ALBERT HENSLEY JR. D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENSLEY
Provider First Name:
BENJAMIN
Provider Middle Name:
ALBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
D.O.
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:
1366574832
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3895 STATE LINE RD.
Provider Second Line Business Mailing Address:
UNIT 209
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64111-3843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-323-6064
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
KU MEDICAL CENTER DIV OF PULMONARY &
Provider Second Line Business Practice Location Address:
3901 RAINBOW BLVD, MS SUDLER HALL 4030
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66160-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-323-6064
Provider Business Practice Location Address Fax Number:
913-588-4098
Provider Enumeration Date:
03/11/2007

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: 207R00000X , with the licence number:  05-36583 , 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)





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