1790853968 NPI number — PULMONARY MEDICINE ASSOC P C

Table of content: MS. SANDRA L. ADDISON L.C.S.W. (NPI 1114935202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790853968 NPI number — PULMONARY MEDICINE ASSOC P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PULMONARY MEDICINE ASSOC P C
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:
1790853968
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8901 W 74TH ST
Provider Second Line Business Mailing Address:
#348
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66204-2204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-432-8000
Provider Business Mailing Address Fax Number:
913-432-3144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8901 W 74TH ST
Provider Second Line Business Practice Location Address:
#348
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66204-2204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-432-8000
Provider Business Practice Location Address Fax Number:
913-432-3144
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOTTS
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
913-432-8000

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  0418793 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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