1801843966 NPI number — MS. SHANTEL R WESTBROOK LMLP/LCP

Table of content: MS. SHANTEL R WESTBROOK LMLP/LCP (NPI 1801843966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801843966 NPI number — MS. SHANTEL R WESTBROOK LMLP/LCP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WESTBROOK
Provider First Name:
SHANTEL
Provider Middle Name:
R
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMLP/LCP
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:
1801843966
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
635 N MAIN ST
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:
67203-3602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-660-7600
Provider Business Mailing Address Fax Number:
316-660-7510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 E 2ND ST
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67202-2504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-660-7800
Provider Business Practice Location Address Fax Number:
316-941-5060
Provider Enumeration Date:
05/27/2006

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: 103TC0700X , with the licence number:  0437 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 0181 , 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: 4204 . This is a "PREFERRED HEALTH SYSTEMS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 392666 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 2153197 . This is a "CIGNA" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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