1295758365 NPI number — JEFFREY T MACMILLAN M.D.

Table of content: KARA HEISTERBERG PT (NPI 1831606342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295758365 NPI number — JEFFREY T MACMILLAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACMILLAN
Provider First Name:
JEFFREY
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1295758365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 920
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TORRINGTON
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82240-0920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-894-2121
Provider Business Mailing Address Fax Number:
913-894-9592

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 W 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIMBALL
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69145-1706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-235-1951
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  04-25519 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 29753 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200030413 . This is a "RR MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100171940A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 431793993 . This is a "TRIWEST" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 0982140 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 141094900 . This is a "US DEPARTMENT OF LABOR" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 15076140 . This is a "HUMANA" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 208162701 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21793010 . This is a "BCBS KC" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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