1407122567 NPI number — SHEBA KHALID MD, LLC.

Table of content: MR. RONALD ALLEN MCCORKLE DC (NPI 1093894677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407122567 NPI number — SHEBA KHALID MD, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHEBA KHALID MD, 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:
1407122567
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10965 GRANADA LN
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66211-1469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-663-3000
Provider Business Mailing Address Fax Number:
913-663-2405

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10965 GRANADA LN
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66211-1469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-663-3000
Provider Business Practice Location Address Fax Number:
913-663-2405
Provider Enumeration Date:
03/22/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KHALID
Authorized Official First Name:
SHEBA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
913-663-3000

Provider Taxonomy Codes

  • Taxonomy code: 2084P0804X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0805X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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