1538509724 NPI number — DR. WILLIAM BALLEW MCCOLLUM M.D.

Table of content: DR. WILLIAM BALLEW MCCOLLUM M.D. (NPI 1538509724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538509724 NPI number — DR. WILLIAM BALLEW MCCOLLUM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCOLLUM
Provider First Name:
WILLIAM
Provider Middle Name:
BALLEW
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1538509724
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 5TH AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEAVENWORTH
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-912-9630
Provider Business Mailing Address Fax Number:
913-682-3880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 E. 12TH ST.
Provider Second Line Business Practice Location Address:
12TH FLOOR
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-936-5140
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2013

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: 202C00000X , with the licence number:  04-13926 , 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)





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