1548353899 NPI number — INTENSIVE DIABETES MANAGEMENT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548353899 NPI number — INTENSIVE DIABETES MANAGEMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTENSIVE DIABETES MANAGEMENT
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:
1548353899
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12352
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66112-0352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-596-3940
Provider Business Mailing Address Fax Number:
913-596-3950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8919 PARALLEL PKWY
Provider Second Line Business Practice Location Address:
SUITE 360
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66112-1636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-596-3940
Provider Business Practice Location Address Fax Number:
913-596-3950
Provider Enumeration Date:
10/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PAQUETTE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
913-596-4000

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 34213011 . This is a "BCBS KANSAS CITY" identifier . This identifiers is of the category "OTHER".




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