1407859119 NPI number — COTTONWOOD PEDIATRICS, PA

Table of content: (NPI 1407859119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407859119 NPI number — COTTONWOOD PEDIATRICS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COTTONWOOD PEDIATRICS, PA
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:
1407859119
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 725
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67114-0725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-283-3627
Provider Business Mailing Address Fax Number:
316-283-3635

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
STE 150
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67114-9015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-283-7100
Provider Business Practice Location Address Fax Number:
316-283-7118
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JANTZ
Authorized Official First Name:
SUE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
316-283-7100

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  0422944 , 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: 193782 . This is a "COVENTRY" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 20418430A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 841639497 . This is a "CENTURY HEALTH" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 841639497 . This is a "CIGNA" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 1615419 . This is a "FIRST HEALTH" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 111290 . This is a "BLUE CROSS / BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 841639497 . This is a "PHCS/PRINCIPAL" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100403 . This is a "HEALTH PARTNERS OF KANSAS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100403 . This is a "AETNA" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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