1962580183 NPI number — JOHN S FRIED, MD

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 1962580183 NPI number — JOHN S FRIED, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN S FRIED, MD
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:
1962580183
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2705
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHAWNEE MISSION
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66201-2705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-248-9693
Provider Business Mailing Address Fax Number:
913-248-9383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8800 W 75TH ST
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66204-2205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-722-4240
Provider Business Practice Location Address Fax Number:
913-722-0012
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRIED
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
913-722-4240

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  18381 , 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: 08236018 . This is a "BLUE SHIELD KANSAS CITY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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