Provider Demographics
NPI:1003415290
Name:MCGINNIS, BARRY TYRONE
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:TYRONE
Last Name:MCGINNIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 SE 23RD TER
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66605-3534
Mailing Address - Country:US
Mailing Address - Phone:785-383-5084
Mailing Address - Fax:
Practice Address - Street 1:3305 SE 23RD TER
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66605-3534
Practice Address - Country:US
Practice Address - Phone:785-383-5084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSK02196973343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS81-1562687Medicaid