1639121635 NPI number — WESTPORT ANESTHESIA SERVICES OF KANSAS PA

Table of content: (NPI 1639121635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639121635 NPI number — WESTPORT ANESTHESIA SERVICES OF KANSAS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTPORT ANESTHESIA SERVICES OF KANSAS PA
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:
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:
1639121635
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9233 WARD PKWY
Provider Second Line Business Mailing Address:
SUITE 230
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64114-3366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-389-6030
Provider Business Mailing Address Fax Number:
816-389-6034

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12300 METCALF AVE
Provider Second Line Business Practice Location Address:
ANESTHESIA DEPT
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66213-1324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-389-6030
Provider Business Practice Location Address Fax Number:
816-389-6034
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DYER
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
816-389-6030

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 049966 . This is a "KS FHP GROUP NUMBER" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 405260 . This is a "BCBS-KS GROUP NUMBER" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: CG1847 . This is a "RR MEDICARE GROUP NUMBER" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 26436019 . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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