1427225838 NPI number — JARAD M. WAITE, OD, PA

Table of content: (NPI 1427225838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427225838 NPI number — JARAD M. WAITE, OD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JARAD M. WAITE, OD, 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:
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:
1427225838
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
311 NW 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABILENE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-263-2020
Provider Business Mailing Address Fax Number:
785-263-1290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 NW 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABILENE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67410-2632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-263-2020
Provider Business Practice Location Address Fax Number:
785-263-1290
Provider Enumeration Date:
05/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WAITE
Authorized Official First Name:
JARAD
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
785-263-2020

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1667 , 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: 1427225838 . This is a "NPI" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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