1649482183 NPI number — RONALD J. JUENEMANN, O.D., P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649482183 NPI number — RONALD J. JUENEMANN, O.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RONALD J. JUENEMANN, O.D., P.A.
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:
1649482183
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 509
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILLIPSBURG
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-543-2715
Provider Business Mailing Address Fax Number:
785-543-6556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
655 5TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILLIPSBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-543-2715
Provider Business Practice Location Address Fax Number:
785-543-6556
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JUENEMANN
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
785-543-2715

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  13993 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1952408221 . This is a "INDIVIDUAL NPI NUMBER" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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