1629446851 NPI number — ALISDAIR RODERIC PHILP PHD, MS

Table of content: ALISDAIR RODERIC PHILP PHD, MS (NPI 1629446851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629446851 NPI number — ALISDAIR RODERIC PHILP PHD, MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILP
Provider First Name:
ALISDAIR
Provider Middle Name:
RODERIC
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD, MS
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:
1629446851
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 BLACKHAWK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64098-1103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-720-5036
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2330 SHAWNEE MISSION PKWY
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
WESTWOOD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66205-2005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-945-8576
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/03/2015

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: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com