1649583014 NPI number — SEAN K CONROY PA-C

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 1649583014 NPI number — SEAN K CONROY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONROY
Provider First Name:
SEAN
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1649583014
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
08/28/2020
NPI Reactivation Date:
09/18/2020

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 969
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DIGHTON
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67839-0969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-397-5321
Provider Business Mailing Address Fax Number:
620-397-2823

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
235 W VINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DIGHTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67839-5089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-397-5321
Provider Business Practice Location Address Fax Number:
620-397-2823
Provider Enumeration Date:
07/14/2010

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: 363A00000X , with the licence number:  1592 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 15-01390 , 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: P00862311 . This is a "RR MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com