1376619635 NPI number — GERHARD W CIBIS MD PC

Table of content: (NPI 1376619635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376619635 NPI number — GERHARD W CIBIS MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERHARD W CIBIS MD PC
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:
1376619635
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:
4620 J C NICHOLS PKWY
Provider Second Line Business Mailing Address:
421
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64112-1617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-561-0306
Provider Business Mailing Address Fax Number:
816-531-7166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4620 J C NICHOLS PKWY
Provider Second Line Business Practice Location Address:
421
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64112-1617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-561-0306
Provider Business Practice Location Address Fax Number:
816-531-7166
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
DENEANE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE COORDINATOR
Authorized Official Telephone Number:
913-491-0765

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 08196015 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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