NPI |
1295792224 |
The State code in the location of the provider
being identified. |
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
KANSAS CITY PULMONARY CLINIC PA |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider First Line Business Practice Location Address |
6420 PROSPECT AVENUE T303 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Second Line Business Practice Location Address |
KANSAS CITY PULMONARY CLINIC PA |
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot
include a Post Office box. |
Provider Business Practice Location Address City Name |
KANSAS CITY |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
MO |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
64132 |
The code designating the provider’s gender if the provider is a person. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
8163331919 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
8163611930 |
The fax number associated with the location
address of the provider being identified. |
Provider Enumeration Date |
4/26/2006 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
8/22/2020 |
The date that a record was last updated or changed. |
Authorized Official Last Name |
WAGNER |
|
Authorized Official First Name |
LINDA |
The first name of the authorized official. |
Authorized Official Title or Position |
PRACTICE MANAGER |
The title or position of the authorized official. |
Authorized Official Telephone Number |
8163331919 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
207R00000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
X |
|
Healthcare Provider Taxonomy Code 2 |
207RP1001X |
|
Healthcare Provider Primary Taxonomy Switch 2 |
X |
|
Other Provider Identifier 1 |
10021231A |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
Other Provider Identifier Type Code 1 |
05 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
Other Provider Identifier State 1 |
KS |
|
Is Organization Subpart |
N |
|
Authorized Official Name Prefix Text |
MS. |
|
Healthcare Provider Taxonomy Group 1 |
193200000X MULTI-SPECIALTY GROUP |
|
Healthcare Provider Taxonomy Group 2 |
193200000X MULTI-SPECIALTY GROUP |
|