1669422473 NPI number — EDEN WHEELER M.D.

Table of content: EDEN WHEELER M.D. (NPI 1669422473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669422473 NPI number — EDEN WHEELER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHEELER
Provider First Name:
EDEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1669422473
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2014
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 362
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:
816-442-7141
Provider Business Mailing Address Fax Number:
816-442-7143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9233 WARD PKWY
Provider Second Line Business Practice Location Address:
SUITE 362
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64114-3366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-442-7141
Provider Business Practice Location Address Fax Number:
816-442-7143
Provider Enumeration Date:
05/11/2006

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: 208100000X , with the licence number:  04-25286 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208100000X , with the licence number: 105924 , 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: 48-1225035 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 481225035 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2135088 . This is a "BC/BS OF KC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 104046 . This is a "BC/BS OF KS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 222843 . This is a "COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00226196 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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