1841297934 NPI number — DR. BRUCE E ZIMMERMAN MD

Table of content: DR. BRUCE E ZIMMERMAN MD (NPI 1841297934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841297934 NPI number — DR. BRUCE E ZIMMERMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZIMMERMAN
Provider First Name:
BRUCE
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
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:
1841297934
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 874480
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64187-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-764-2737
Provider Business Mailing Address Fax Number:
913-764-7502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20375 W. 151ST ST
Provider Second Line Business Practice Location Address:
SUITE 106A
Provider Business Practice Location Address City Name:
OLATHE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66061-5353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-764-2737
Provider Business Practice Location Address Fax Number:
913-764-7502
Provider Enumeration Date:
07/05/2005

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: 207Y00000X , with the licence number:  04-18507 , 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: 263013 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: D446804 . This is a "MEDICARE KC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13644031 . This is a "BCBS KC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 402512 . This is a "BCBS KS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 040013096 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".




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