1760166128 NPI number — CARE ND PROVIDER GROUP OF KANSAS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760166128 NPI number — CARE ND PROVIDER GROUP OF KANSAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE ND PROVIDER GROUP OF KANSAS
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:
1760166128
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CAREND PROVIDER GROUP OF KANSAS
Provider Second Line Business Mailing Address:
12022 BLUE VALLEY PARKWAY SUITE 514
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-630-1534
Provider Business Mailing Address Fax Number:
888-517-8619

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CAREND PROVIDER GROUP OF KANSAS
Provider Second Line Business Practice Location Address:
12022 BLUE VALLEY PARKWAY SUITE 514
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-630-1534
Provider Business Practice Location Address Fax Number:
888-517-8619
Provider Enumeration Date:
06/14/2023

Additional Information

Authorized Official

Authorized Official Last Name:
ZIDAN
Authorized Official First Name:
AWSS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-239-9455

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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