1427220375 NPI number — CARONDELET PHYSICIAN SERVICES INC

Table of content: (NPI 1427220375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427220375 NPI number — CARONDELET PHYSICIAN SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARONDELET PHYSICIAN SERVICES INC
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:
1427220375
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 NW SAINT MARY DR
Provider Second Line Business Mailing Address:
SUITE 230
Provider Business Mailing Address City Name:
BLUE SPRINGS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64014-2524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-655-5792
Provider Business Mailing Address Fax Number:
816-655-5787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 NW MOCK AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BLUE SPRINGS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64014-2543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-220-3100
Provider Business Practice Location Address Fax Number:
816-220-4738
Provider Enumeration Date:
04/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CLEARY
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
816-943-2819

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  R6P77 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 39532013 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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