1750485074 NPI number — PRESBYTERIAN MANORS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750485074 NPI number — PRESBYTERIAN MANORS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESBYTERIAN MANORS, 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:
6
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:
1750485074
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20440
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67208-1440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-685-1100
Provider Business Mailing Address Fax Number:
316-685-2900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7850 FREEMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66112-2133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-334-3666
Provider Business Practice Location Address Fax Number:
913-334-2904
Provider Enumeration Date:
09/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WARD
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
316-685-1100

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  N/A , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 90245014 . This is a "BCBS KANSAS CITY" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 899973 . This is a "BLUE CROSS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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