1447247218 NPI number — DR. BONNIE K GOINS MD

Table of content: DR. BONNIE K GOINS MD (NPI 1447247218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447247218 NPI number — DR. BONNIE K GOINS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOINS
Provider First Name:
BONNIE
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1447247218
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
902 N RIVERSIDE RD STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT JOSEPH
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64507-2566
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-271-7280
Provider Business Mailing Address Fax Number:
816-271-1047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
902 N RIVERSIDE RD
Provider Second Line Business Practice Location Address:
#201
Provider Business Practice Location Address City Name:
SAINT JOSEPH
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64507-2559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-271-7280
Provider Business Practice Location Address Fax Number:
816-271-1047
Provider Enumeration Date:
10/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  100270 , 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: 21473026 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 203823505 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00092604 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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