1710366539 NPI number — MR. COLIN GREGORY WARNOCK AA-C

Table of content: MR. COLIN GREGORY WARNOCK AA-C (NPI 1710366539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710366539 NPI number — MR. COLIN GREGORY WARNOCK AA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARNOCK
Provider First Name:
COLIN
Provider Middle Name:
GREGORY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
AA-C
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:
1710366539
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1905 S DRUMM AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64055-1836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-204-0018
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 E PRIMROSE ST STE 520
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65807-5180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-204-0018
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2015

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: 367H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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