1609124718 NPI number — ALAN D BANWART LSCSW

Table of content: ALAN D BANWART LSCSW (NPI 1609124718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609124718 NPI number — ALAN D BANWART LSCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANWART
Provider First Name:
ALAN
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LSCSW
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:
1609124718
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7839 W 197TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STILWELL
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66085-9508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-589-1058
Provider Business Mailing Address Fax Number:
888-389-5175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14221 METCALF AVE STE 119
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66223-3301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-353-6053
Provider Business Practice Location Address Fax Number:
888-389-5175
Provider Enumeration Date:
08/21/2012

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: 1041C0700X , with the licence number:  4318 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 104100000X , with the licence number: 2011025106 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200653410D , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".