1922092600 NPI number — MRS. SHELBY ELIZABETH BURTON RPT

Table of content: MRS. SHELBY ELIZABETH BURTON RPT (NPI 1922092600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922092600 NPI number — MRS. SHELBY ELIZABETH BURTON RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURTON
Provider First Name:
SHELBY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPT
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:
1922092600
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5524 NE SUNSHINE DR
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:
64064-2478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-795-6153
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 SWIFT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64116-3426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-474-8877
Provider Business Practice Location Address Fax Number:
816-474-8878
Provider Enumeration Date:
09/08/2005

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: 225100000X , with the licence number:  117171 , 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)





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