1588220578 NPI number — APOLLO MEDICAL GROUP OF OVERLAND PARK LLC

Table of content: (NPI 1588220578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588220578 NPI number — APOLLO MEDICAL GROUP OF OVERLAND PARK LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APOLLO MEDICAL GROUP OF OVERLAND PARK LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588220578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3286
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62708-3286
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-360-1566
Provider Business Mailing Address Fax Number:
941-358-9818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6650 W 110TH ST STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66211-1546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-469-6777
Provider Business Practice Location Address Fax Number:
913-469-4046
Provider Enumeration Date:
05/15/2019

Additional Information

Authorized Official

Authorized Official Last Name:
VAN SPRUNDEL
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF ADMINISTRATION
Authorized Official Telephone Number:
941-725-1198

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com