1942377320 NPI number — GREGORY L HUMMEL MD PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942377320 NPI number — GREGORY L HUMMEL MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREGORY L HUMMEL MD PC
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:
1942377320
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1980
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64055-0980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-642-4900
Provider Business Mailing Address Fax Number:
913-381-0979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19550 E 39TH ST S
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64057-2303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-252-7300
Provider Business Practice Location Address Fax Number:
816-836-8435
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUMMEL
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
816-252-7300

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 505821702 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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