1881644540 NPI number — NEW MARKET HEALTH CARE LLC

Table of content: (NPI 1881644540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881644540 NPI number — NEW MARKET HEALTH CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW MARKET HEALTH CARE 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:
NEW MEDICAL HEALTH CARE LLC
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:
1881644540
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 1389
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JUNCTION CITY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66441-1389
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-773-1212
Provider Business Mailing Address Fax Number:
316-440-6601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2131 N RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67212-1570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-773-1212
Provider Business Practice Location Address Fax Number:
316-440-6601
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAKIN
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
316-773-1212

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200000670A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110965 . This is a "BCBS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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