1699769885 NPI number — DR. LELAND H ROBINSON III MD

Table of content: DR. LELAND H ROBINSON III MD (NPI 1699769885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699769885 NPI number — DR. LELAND H ROBINSON III MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBINSON
Provider First Name:
LELAND
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
MD
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:
1699769885
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11157
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64119-0157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-234-1350
Provider Business Mailing Address Fax Number:
913-234-1108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 CLAY EDWARDS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64116-3220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-346-7220
Provider Business Practice Location Address Fax Number:
816-346-7242
Provider Enumeration Date:
09/02/2005

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: 207P00000X , with the licence number:  2004020027 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 35775018 . This is a "BCBS KC MO" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00230963 . This is a "RR MEDICARE GROUP CD1534" identifier . This identifiers is of the category "OTHER".