1205932308 NPI number — MRS. CARMETA DENISE SHAW-JONES CRNA

Table of content: MRS. CARMETA DENISE SHAW-JONES CRNA (NPI 1205932308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205932308 NPI number — MRS. CARMETA DENISE SHAW-JONES CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAW-JONES
Provider First Name:
CARMETA
Provider Middle Name:
DENISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

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:
1205932308
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
EXCEL ANESTHESIA, LLC
Provider Second Line Business Mailing Address:
13851 W. 63RD ST., SUITE 433
Provider Business Mailing Address City Name:
SHAWNEE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66216-3800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-721-3641
Provider Business Mailing Address Fax Number:
913-721-3649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EPIC EYE SURGERY CENTER, LLC
Provider Second Line Business Practice Location Address:
11261 NALL AVENUE #200
Provider Business Practice Location Address City Name:
LEAWOOD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-671-3290
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  43-54461-011 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 108387 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100251390D , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1205932308 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".