Basic Information
Provider Information | |||||||||
NPI: | 1659597136 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BAEHL | ||||||||
FirstName: | KEVIN | ||||||||
MiddleName: | PAUL | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1550 E REPUBLIC RD | ||||||||
Address2: |   | ||||||||
City: | SPRINGFIELD | ||||||||
State: | MO | ||||||||
PostalCode: | 658046530 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4178896102 | ||||||||
FaxNumber: | 4178896289 | ||||||||
Practice Location | |||||||||
Address1: | 3801 S NATIONAL AVE | ||||||||
Address2: | COX HOSPITAL-DEPT OF RADIOLOGY | ||||||||
City: | SPRINGFIELD | ||||||||
State: | MO | ||||||||
PostalCode: | 658075210 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4172694056 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/17/2007 | ||||||||
LastUpdateDate: | 07/26/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | 35-094877 | OH | N |   | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085D0003X | 35-094877 | OH | N |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Neuroimaging | 2085U0001X | 35-094877 | OH | N |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 2085H0002X | 35-094877 | OH | N |   | Allopathic & Osteopathic Physicians | Radiology | Hospice and Palliative Medicine | 2085N0700X | 35-094877 | OH | N |   | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | 35-094877 | OH | N |   | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085P0229X | 35-094877 | OH | N |   | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0001X | 35-094877 | OH | N |   | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0203X | 35-094877 | OH | N |   | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology | 2085R0204X | 35-094877 | OH | N |   | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 207U00000X | 35-094877 | OH | N |   | Allopathic & Osteopathic Physicians | Nuclear Medicine |   | 207UN0903X | 35-094877 | OH | N |   | Allopathic & Osteopathic Physicians | Nuclear Medicine | In Vivo & In Vitro Nuclear Medicine | 207UN0902X | 35-094877 | OH | N |   | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Imaging & Therapy | 207UN0901X | 35-094877 | OH | N |   | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology | 2085R0202X | 2011009903 | MO | Y |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
ID | Type | State | Issuer | Description | 3047027 | 05 | OH |   | MEDICAID |