1801857891 NPI number — LARRY C HOLLENBECK MD

Table of content: LARRY C HOLLENBECK MD (NPI 1801857891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801857891 NPI number — LARRY C HOLLENBECK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLENBECK
Provider First Name:
LARRY
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1801857891
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2790 CLAY EDWARDS DR
Provider Second Line Business Mailing Address:
SUITE 1235
Provider Business Mailing Address City Name:
NORTH KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64116-3276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-472-5157
Provider Business Mailing Address Fax Number:
816-472-7201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2790 CLAY EDWARDS DR
Provider Second Line Business Practice Location Address:
SUITE 1235
Provider Business Practice Location Address City Name:
NORTH KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64116-3276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-472-5157
Provider Business Practice Location Address Fax Number:
816-472-7201
Provider Enumeration Date:
03/29/2006

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: 2084N0400X , with the licence number:  R6F61 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084N0400X , with the licence number: 04-20159 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3230500-0002 . This is a "CIGNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 12416018 . This is a "BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 206664914 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 206664906 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 453014 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 10001511401 . This is a "COMMUNITY HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 0508022 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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