1386726404 NPI number — THOMAS L TAYLOR MD CHARTERED

Table of content: (NPI 1386726404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386726404 NPI number — THOMAS L TAYLOR MD CHARTERED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS L TAYLOR MD CHARTERED
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:
1386726404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8901 W 74TH ST
Provider Second Line Business Mailing Address:
#124
Provider Business Mailing Address City Name:
SHAWNEE MISSION
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66204-2204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-362-9444
Provider Business Mailing Address Fax Number:
913-362-9399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8901 W 74TH ST
Provider Second Line Business Practice Location Address:
#124
Provider Business Practice Location Address City Name:
SHAWNEE MISSION
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66204-2204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-362-9444
Provider Business Practice Location Address Fax Number:
913-362-9399
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
913-362-9444

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  0413808 , 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)

  • Identifier: 01807014 . This is a "BCBS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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