1710940895 NPI number — DR. RUTH E MILLETT MD

Table of content: DR. RUTH E MILLETT MD (NPI 1710940895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710940895 NPI number — DR. RUTH E MILLETT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLETT
Provider First Name:
RUTH
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1710940895
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 52990
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWOOD
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29649-0048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-223-3600
Provider Business Mailing Address Fax Number:
843-223-6054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7301 COLLEGE BLVD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66210-1937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-341-6297
Provider Business Practice Location Address Fax Number:
913-341-6299
Provider Enumeration Date:
04/10/2006

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: 207ZP0102X , with the licence number:  R5538 , 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: 201871118 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100122000B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 709960 . This is a "KS BCBS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 09952050 . This is a "KANSAS CTY BCBS" identifier . This identifiers is of the category "OTHER".




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