1497708077 NPI number — KENNETH C KASPER MD

Table of content: KENNETH C KASPER MD (NPI 1497708077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497708077 NPI number — KENNETH C KASPER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KASPER
Provider First Name:
KENNETH
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
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:
1497708077
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4301 W MARKHAM ST # 783
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72205-7101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-686-8000
Provider Business Mailing Address Fax Number:
501-526-5148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4301 W MARKHAM ST # 515
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-7101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-686-6114
Provider Business Practice Location Address Fax Number:
501-686-8139
Provider Enumeration Date:
05/18/2006

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: 207L00000X , with the licence number:  E-17007 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207L00000X , with the licence number: 30214 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 50068058 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 204780415 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00121591 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3124467 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 139197001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3830558 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 97983 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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