1912015389 NPI number — DR. JOY ELEANOR CUEZZE MD

Table of content: DR. JOY ELEANOR CUEZZE MD (NPI 1912015389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912015389 NPI number — DR. JOY ELEANOR CUEZZE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUEZZE
Provider First Name:
JOY
Provider Middle Name:
ELEANOR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEINKAMP
Provider Other First Name:
JOY
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1912015389
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 SW LONGVIEW BLVD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEES SUMMIT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64081-2116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-279-5960
Provider Business Mailing Address Fax Number:
877-384-3106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 SW LONGVIEW BLVD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEES SUMMIT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64081-2116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-279-5960
Provider Business Practice Location Address Fax Number:
877-384-3106
Provider Enumeration Date:
08/27/2006

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: 207QG0300X , with the licence number:  2002015737 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 2002015737 , 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: 207628405 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".