1417220534 NPI number — ABDEL KARIM HASAN JABER TAYIEM, M.D., P.A.

Table of content: (NPI 1417220534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417220534 NPI number — ABDEL KARIM HASAN JABER TAYIEM, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABDEL KARIM HASAN JABER TAYIEM, M.D., P.A.
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:
6
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:
1417220534
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 COMMERCIAL ST
Provider Second Line Business Mailing Address:
STE 7
Provider Business Mailing Address City Name:
ATCHISON
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66002-2402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-367-3900
Provider Business Mailing Address Fax Number:
913-367-3904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 COMMERCIAL ST
Provider Second Line Business Practice Location Address:
STE 7
Provider Business Practice Location Address City Name:
ATCHISON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66002-2402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-367-3900
Provider Business Practice Location Address Fax Number:
913-367-3904
Provider Enumeration Date:
02/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
TAYIEM
Authorized Official First Name:
ABDEL
Authorized Official Middle Name:
KARIM HASAN JABER
Authorized Official Title or Position:
PRESIDENT OF CORPORATION
Authorized Official Telephone Number:
913-367-3900

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 020009556 . This is a "PALMETTO GBA- RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 08677011 . This is a "BLUE CROSS BLUE SHIELD OF KANSAS CITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1700416 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1851384309 . This is a "UNICARE HEALTH PLAN OF KANSAS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100082110 C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 136352 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 263689 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 002603 . This is a "MEDICARE PTAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100082110 B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1851384309 . This is a "INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4583740 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 462005 . This is a "CHILDRENS MERCY FAMILY HEALTH PARTNERS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 10898 . This is a "COVENTRY HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200650307 . This is a "MEDICAID OF MISSOURI" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 3742 . This is a "PEFERRED HEALTH SYSTEMS" identifier . This identifiers is of the category "OTHER".




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