1568439263 NPI number — AMANDA M CANADY CRNA

Table of content: AMANDA M CANADY CRNA (NPI 1568439263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568439263 NPI number — AMANDA M CANADY CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANADY
Provider First Name:
AMANDA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIMON
Provider Other First Name:
AMANDA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1568439263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67114-8780
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-283-2700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67114-8780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-281-3700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2006

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: 367500000X , with the licence number:  682127 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 092543 . This is a "RE-CERT #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 172351201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84799U . This is a "BCBS PROV #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 200050380A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200423560A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145437 . This is a "BCBS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".