1982858593 NPI number — MID AMERICA BALANCE INSTITUTE OF CLAY PLATTE COUNTY MISSOURI

Table of content: (NPI 1982858593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982858593 NPI number — MID AMERICA BALANCE INSTITUTE OF CLAY PLATTE COUNTY MISSOURI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID AMERICA BALANCE INSTITUTE OF CLAY PLATTE COUNTY MISSOURI
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:
MABI OF CLAY PLATTE
Provider Other Organization Name Type Code:
3
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:
1982858593
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
373 W 101ST TER
Provider Second Line Business Mailing Address:
#200
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64114-4408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-246-1456
Provider Business Mailing Address Fax Number:
816-286-2774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
373 W 101ST TER
Provider Second Line Business Practice Location Address:
#200
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64114-4408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-246-1456
Provider Business Practice Location Address Fax Number:
816-286-2774
Provider Enumeration Date:
11/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LAMPE
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
913-221-1148

Provider Taxonomy Codes

  • Taxonomy code: 225500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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