1811293582 NPI number — CARONDELET PHYSICIAN SERVICES 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 1811293582 NPI number — CARONDELET PHYSICIAN SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARONDELET PHYSICIAN SERVICES 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:
1811293582
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 NW SAINT MARY DR
Provider Second Line Business Mailing Address:
SUITE 230
Provider Business Mailing Address City Name:
BLUE SPRINGS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64014-2524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-655-5792
Provider Business Mailing Address Fax Number:
816-655-5787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 S BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK GROVE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64075-9020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-690-6566
Provider Business Practice Location Address Fax Number:
816-625-8276
Provider Enumeration Date:
01/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CLEARY
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
VP/CFO
Authorized Official Telephone Number:
816-943-2819

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  34421 , 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: 501269500 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 39532013 . This is a "BCBS OF KANSAS CITY" identifier . This identifiers is of the category "OTHER".




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