1467436626 NPI number — SUTHON CHATKUPT M.D.

Table of content: SUTHON CHATKUPT M.D. (NPI 1467436626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467436626 NPI number — SUTHON CHATKUPT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHATKUPT
Provider First Name:
SUTHON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1467436626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 RAINBOW BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EXCELSIOR SPRINGS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64024-1182
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-629-2743
Provider Business Mailing Address Fax Number:
816-629-2708

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 RAINBOW BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EXCELSIOR SPRINGS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64024-1182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-629-2743
Provider Business Practice Location Address Fax Number:
816-629-2708
Provider Enumeration Date:
12/01/2005

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: 208600000X , with the licence number:  33979 , 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: 3127327007 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4035241 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200236933 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1042753 . This is a "ECFMG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431726195 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100240 . This is a "FIRST GUARD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10270 . This is a "BUNN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 17080111 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 36553 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 709912 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 021577062 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10001311700 . This is a "COMMUNITY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 301800 . This is a "FAMILY HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00297056 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33825 . This is a "HEALTHCARE USA" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com