Provider Demographics
NPI:1114439957
Name:HENTGES, ZACH G
Entity Type:Individual
Prefix:
First Name:ZACH
Middle Name:G
Last Name:HENTGES
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 1:303 S SANDIA ST
Mailing Address - Street 2:
Mailing Address - City:CONCORDIA
Mailing Address - State:MO
Mailing Address - Zip Code:64020-8342
Mailing Address - Country:US
Mailing Address - Phone:816-447-8984
Mailing Address - Fax:
Practice Address - Street 1:411 CENTRAL METHODIST SQ
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MO
Practice Address - Zip Code:65248-1104
Practice Address - Country:US
Practice Address - Phone:660-248-3391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer