1902898265 NPI number — DR. GUILLERMO E GARCIA-ORDENES MD

Table of content: DR. GUILLERMO E GARCIA-ORDENES MD (NPI 1902898265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902898265 NPI number — DR. GUILLERMO E GARCIA-ORDENES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARCIA-ORDENES
Provider First Name:
GUILLERMO
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:
GARCIA
Provider Other First Name:
BILL
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1902898265
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 913041
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80291-3041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-275-3700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 E SPRUCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-275-3030
Provider Business Practice Location Address Fax Number:
620-275-3025
Provider Enumeration Date:
08/22/2005

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: 207X00000X , with the licence number:  04-16930 , 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: 100195630 A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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