1790719276 NPI number — MINNIE J BALDRIDGE AUD, CCC-A

Table of content: MINNIE J BALDRIDGE AUD, CCC-A (NPI 1790719276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790719276 NPI number — MINNIE J BALDRIDGE AUD, CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALDRIDGE
Provider First Name:
MINNIE
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AUD, CCC-A
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:
1790719276
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6528 RAYTOWN RD STE I
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAYTOWN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64133-5023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-737-0055
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8424 CLINT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64012-5329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-322-8883
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2006

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: 237600000X , with the licence number:  1952 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237700000X , with the licence number: 1952 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: 1952 , 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: 2001004845 . This is a "MISSOURI LICENSE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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