1215121629 NPI number — RANDALL KUNZE DPM LLC

Table of content: (NPI 1215121629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215121629 NPI number — RANDALL KUNZE DPM LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RANDALL KUNZE DPM LLC
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:
1215121629
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 424
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARTHAGE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64836-0424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-358-8566
Provider Business Mailing Address Fax Number:
417-358-2428

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1503 HAZEL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARTHAGE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64836-2829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-358-8566
Provider Business Practice Location Address Fax Number:
417-358-2428
Provider Enumeration Date:
08/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KUNZE
Authorized Official First Name:
RANDALL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
417-358-8566

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  000634 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X , with the licence number: 000634 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: 000634 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 506137108 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00350052 . This is a "MC RAILROAD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 9912 . This is a "BCBS MO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 302951702 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139389 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: DF2473 . This is a "MC RAILROAD GROUP" identifier . This identifiers is of the category "OTHER".




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