1518007905 NPI number — KVC BEHAVIORAL HEALTHCARE

Table of content: MCSHIRLEY MATH TRAN PA (NPI 1184108490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518007905 NPI number — KVC BEHAVIORAL HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KVC BEHAVIORAL HEALTHCARE
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:
1518007905
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21350 W 153RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLATHE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66061-5413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-322-4900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21350 W 153RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLATHE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66061-5413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-322-4900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JAEGER
Authorized Official First Name:
LEA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
ACCOUNTING MANAGER
Authorized Official Telephone Number:
913-322-4934

Provider Taxonomy Codes

  • Taxonomy code: 347C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100007240E , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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