1811014400 NPI number — DR. ANDREW GODBEY M.D.

Table of content: DR. ANDREW GODBEY M.D. (NPI 1811014400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811014400 NPI number — DR. ANDREW GODBEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GODBEY
Provider First Name:
ANDREW
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1811014400
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 801143
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64180-1143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-331-5583
Provider Business Mailing Address Fax Number:
573-331-5079

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3004 GORDONVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAPE GIRARDEAU
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63703-5008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-332-1972
Provider Business Practice Location Address Fax Number:
573-334-4667
Provider Enumeration Date:
03/26/2007

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: 204D00000X , with the licence number:  2005016356 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 2005016356 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00855040 . This is a "RR MCR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1811014400 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100116130 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1811014400 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 673730 . This is a "ANTHEM BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: A11519 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1811014400 . This is a "TRIWEST" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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