1730515933 NPI number — KELLY HOUSE OPERATIONS, LLC

Table of content: (NPI 1730515933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730515933 NPI number — KELLY HOUSE OPERATIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KELLY HOUSE OPERATIONS, LLC
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:
KELLY HOUSE 2
Provider Other Organization Name Type Code:
3
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:
1730515933
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3715 SW 29TH ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOPEKA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66614-2164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-272-1535
Provider Business Mailing Address Fax Number:
785-272-1480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 SW FAIRMONT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66604-3699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-271-9594
Provider Business Practice Location Address Fax Number:
785-271-6638
Provider Enumeration Date:
09/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
TRYON
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
785-272-1535

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  N089034 , 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: 100274660A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com