1457305062 NPI number — DR. LILLARD G ASHLEY JR. MD

Table of content: DR. LILLARD G ASHLEY JR. MD (NPI 1457305062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457305062 NPI number — DR. LILLARD G ASHLEY JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ASHLEY
Provider First Name:
LILLARD
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1457305062
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 SE BLUE PKWY
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
LEES SUMMIT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64063-1041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-607-2950
Provider Business Mailing Address Fax Number:
816-607-2990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 SE BLUE PKWY
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
LEES SUMMIT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64063-1041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-607-2950
Provider Business Practice Location Address Fax Number:
816-607-2990
Provider Enumeration Date:
05/19/2006

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: 207RC0000X , with the licence number:  R6850 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: 0416588 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0004001258 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431092652A027 . This is a "CHAMPUS TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5629254 . This is a "BLUE SHIELD OF KC HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5629254 . This is a "BLUE SHIELD OF KC PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0004001258 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0004001258 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060051904 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5629254 . This is a "PHP FREEDOM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1457305062 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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