=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346246105
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES WESLEY POWELL M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2005
-----------------------------------------------------
Last Update Date | 03/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 N 13TH ST
-----------------------------------------------------
City | LOUISBURG
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66053-3520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-206-3691
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 N 13TH ST
-----------------------------------------------------
City | LOUISBURG
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66053-3520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-206-3691
-----------------------------------------------------
Fax | 913-557-9838
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 2000146137
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 2000146137
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2080N0001X
-----------------------------------------------------
Taxonomy Name | Neonatal-Perinatal Medicine Physician
-----------------------------------------------------
License Number | 2000146137
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------