1548647241 NPI number — DEGOLER'S INC.

Table of content: (NPI 1548647241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548647241 NPI number — DEGOLER'S INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEGOLER'S INC.
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:
1548647241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209-B DELAWARE ST.
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:
913-596-2447
Provider Business Mailing Address Fax Number:
913-428-4947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209B DELAWARE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEAVENWORTH
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66048-2823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-596-2447
Provider Business Practice Location Address Fax Number:
913-428-4947
Provider Enumeration Date:
05/01/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HARTE
Authorized Official First Name:
GLENN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
913-596-2447

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  2-13172 , 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: 2151689 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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