1851457469 NPI number — MIDAMERICA ALLIANCE FOR ACCESS CORPORATION

Table of content: (NPI 1851457469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851457469 NPI number — MIDAMERICA ALLIANCE FOR ACCESS CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDAMERICA ALLIANCE FOR ACCESS CORPORATION
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:
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:
1851457469
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
311 DELAWARE ST.
Provider Second Line Business Mailing Address:
#102 #A
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-321-5140
Provider Business Mailing Address Fax Number:
913-321-5140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 DELAWARE ST.
Provider Second Line Business Practice Location Address:
#102 #A
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-321-5140
Provider Business Practice Location Address Fax Number:
913-321-5140
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DRAKE
Authorized Official First Name:
DENNIS (GARRETT)
Authorized Official Middle Name:
GARRETT
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
913-321-5140

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 2003018091 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 01247 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100033910A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 266257104 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 504580002 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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