1497751648 NPI number — COKINGTIN EYE CENTER PA

Table of content: (NPI 1497751648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497751648 NPI number — COKINGTIN EYE CENTER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COKINGTIN EYE CENTER 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:
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:
1497751648
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5520 COLLEGE BLVD
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66211-1658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-491-3737
Provider Business Mailing Address Fax Number:
913-469-6686

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5520 COLLEGE BLVD
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66211-1658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-491-3737
Provider Business Practice Location Address Fax Number:
913-469-6686
Provider Enumeration Date:
06/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BALESTRIERI
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
913-491-3737

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , 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: 100449800A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 31661011 . This is a "FREEDOM NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 506050319 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 468090 . This is a "BCBSKS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 506050301 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100138550D , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 31661011 . This is a "BCBSKC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 17788 . This is a "SPECTERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31661011 . This is a "PHP" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com