1578583886 NPI number — GARDNER-EDGERTON-ANTIOCH USD 231

Table of content: (NPI 1578583886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578583886 NPI number — GARDNER-EDGERTON-ANTIOCH USD 231

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARDNER-EDGERTON-ANTIOCH USD 231
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:
1578583886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 189
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GIRARD
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66743-0189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-654-8701
Provider Business Mailing Address Fax Number:
620-724-7141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
218 E SHAWNEE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDNER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66030-1320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-856-2080
Provider Business Practice Location Address Fax Number:
913-856-3283
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
913-856-2080

Provider Taxonomy Codes

  • Taxonomy code: 251300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100212060A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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