1548696081 NPI number — MR. CHARLES OTIS WHITTINGTON III M.A.

Table of content: MR. CHARLES OTIS WHITTINGTON III M.A. (NPI 1548696081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548696081 NPI number — MR. CHARLES OTIS WHITTINGTON III M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITTINGTON
Provider First Name:
CHARLES
Provider Middle Name:
OTIS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
M.A.
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:
1548696081
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4010 WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 405
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64111-2609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-200-2262
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4010 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 405
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64111-2609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-200-2262
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2013

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: 101YP2500X , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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