Provider Demographics
NPI:1225080682
Name:BIRCH, JAMES THEODORE JR (MD, MSPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:THEODORE
Last Name:BIRCH
Suffix:JR
Gender:M
Credentials:MD, MSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 411851
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1851
Mailing Address - Country:US
Mailing Address - Phone:913-588-1944
Mailing Address - Fax:913-588-2496
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:MS 4017
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8500
Practice Address - Country:US
Practice Address - Phone:913-588-1944
Practice Address - Fax:193-588-2496
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003026494207Q00000X
KS04032538207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201906013Medicaid
VA010196264Medicaid
MOP00284544OtherRR MEDICARE
MO201906013Medicaid
B05052Medicare UPIN
MO934825236Medicare PIN
VA080001256Medicare ID - Type Unspecified