1649394917 NPI number — KIMBALL GENETICS, INC.

Table of content: (NPI 1649394917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649394917 NPI number — KIMBALL GENETICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIMBALL GENETICS, INC.
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:
1649394917
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 S CHERRY ST
Provider Second Line Business Mailing Address:
SUITE 225
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80246-1801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-320-1807
Provider Business Mailing Address Fax Number:
303-388-9220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 S CHERRY ST
Provider Second Line Business Practice Location Address:
SUITE 225
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80246-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-320-1807
Provider Business Practice Location Address Fax Number:
303-388-9220
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
ANNETTE
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
303-320-1807

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 805613400 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1111361 00 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030939700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 731970238A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101429170 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00070977 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009919290 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08002362 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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