1598873697 NPI number — KIM PAULETTE MILEY DC

Table of content: KIM PAULETTE MILEY DC (NPI 1598873697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598873697 NPI number — KIM PAULETTE MILEY DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILEY
Provider First Name:
KIM
Provider Middle Name:
PAULETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

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:
1598873697
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13095 S MUR LEN RD
Provider Second Line Business Mailing Address:
STE 170
Provider Business Mailing Address City Name:
OLATHE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66062-1250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-393-2611
Provider Business Mailing Address Fax Number:
913-393-3729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13095 S MUR LEN RD
Provider Second Line Business Practice Location Address:
STE 170
Provider Business Practice Location Address City Name:
OLATHE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66062-1250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-393-2611
Provider Business Practice Location Address Fax Number:
913-393-3729
Provider Enumeration Date:
08/28/2006

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: 111N00000X , with the licence number:  01-04684 , 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: 29234016 . This is a "BCBS OF KANSAS CITY" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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