1881726115 NPI number — MS. TRACIE N LENZY

Table of content: MS. TRACIE N LENZY (NPI 1881726115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881726115 NPI number — MS. TRACIE N LENZY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LENZY
Provider First Name:
TRACIE
Provider Middle Name:
N
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
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:
1881726115
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8701 HOLMES RD
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:
64131-2802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-349-3300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8701 HOLMES RD
Provider Second Line Business Practice Location Address:
CENTER 58
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64131-2802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-349-3300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2007

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: 235Z00000X , with the licence number:  111788 , 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: 468073309 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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