1528024742 NPI number — HEALTHY OPTIONS FOR PLANEVIEW

Table of content: (NPI 1528024742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528024742 NPI number — HEALTHY OPTIONS FOR PLANEVIEW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHY OPTIONS FOR PLANEVIEW
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:
6
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:
1528024742
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4501 E 47TH ST S
Provider Second Line Business Mailing Address:
ROOM A104
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67210-1651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-978-8011
Provider Business Mailing Address Fax Number:
316-554-2650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3620 E SUNNYBROOK LN
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67210-1464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-651-5357
Provider Business Practice Location Address Fax Number:
316-651-5357
Provider Enumeration Date:
04/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PICKARD
Authorized Official First Name:
RUTH
Authorized Official Middle Name:
B
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
316-978-5637

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  60019 , 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: 200370570B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200370570A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000421786 . This is a "DENTAL" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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