1578520029 NPI number — MRS. DEBBIE R GRUENBACHER DO

Table of content: MRS. DEBBIE R GRUENBACHER DO (NPI 1578520029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578520029 NPI number — MRS. DEBBIE R GRUENBACHER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRUENBACHER
Provider First Name:
DEBBIE
Provider Middle Name:
R
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BASSHAM
Provider Other First Name:
DEBBIE
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578520029
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8035
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67208-0035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-689-9135
Provider Business Mailing Address Fax Number:
316-689-9667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8444 W 21ST ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67205-1752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-721-9500
Provider Business Practice Location Address Fax Number:
316-721-9574
Provider Enumeration Date:
04/27/2006

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: 207Q00000X , with the licence number:  05-23473 , 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: 003719187 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100232480G , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com