Provider Demographics
NPI:1457485930
Name:J B ASTIK M D P A
Entity Type:Organization
Organization Name:J B ASTIK M D P A
Other - Org Name:J.B. ASTIK, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYENDRA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ASTIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:660-747-8154
Mailing Address - Street 1:511 BURKARTH RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-3103
Mailing Address - Country:US
Mailing Address - Phone:660-747-8154
Mailing Address - Fax:660-747-9757
Practice Address - Street 1:511 BURKARTH RD
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-3103
Practice Address - Country:US
Practice Address - Phone:660-747-8154
Practice Address - Fax:660-747-9757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOAA9372575207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506055805Medicaid
CJ7821OtherRR MEDICARE
MOL400000OtherMEDICARE GROUP PTAN NUMBER
MO30634017OtherKANSAS CITY BCBS
MO30634017OtherKANSAS CITY BCBS