Provider Demographics
NPI:1760438154
Name:NEBLOCK-BEIRNE, TAMMY K (MD)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:K
Last Name:NEBLOCK-BEIRNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:K
Other - Last Name:BEIRNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 504407
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-4407
Mailing Address - Country:US
Mailing Address - Phone:816-932-7940
Mailing Address - Fax:816-932-7957
Practice Address - Street 1:4320 WORNALL RD
Practice Address - Street 2:STE 530
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5941
Practice Address - Country:US
Practice Address - Phone:816-932-2836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101510208600000X
KS426567208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200311950CMedicaid
KS200311950DMedicaid
MO1760438154Medicaid
MO1760438154Medicaid
MOW199422Medicare PIN
KSW19A00018Medicare PIN