1538486816 NPI number — CENTERPOINT MEDICAL SPECIALISTS LLC

Table of content: (NPI 1538486816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538486816 NPI number — CENTERPOINT MEDICAL SPECIALISTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTERPOINT MEDICAL SPECIALISTS LLC
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:
1538486816
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
725 NW STATE ROUTE 7
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
BLUE SPRINGS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64014-2426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-224-8999
Provider Business Mailing Address Fax Number:
816-224-3121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
725 NW STATE ROUTE 7
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
BLUE SPRINGS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64014-2426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-224-8999
Provider Business Practice Location Address Fax Number:
816-224-3121
Provider Enumeration Date:
04/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PICKLER
Authorized Official First Name:
MICKEY
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
816-508-4039

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200690010B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1538486816 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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