1467750232 NPI number — SPORTS MED PLUS OF LEAWOOD LLC

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 1467750232 NPI number — SPORTS MED PLUS OF LEAWOOD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPORTS MED PLUS OF LEAWOOD 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:
1467750232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2741 NE MCBAIN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEES SUMMIT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64064-7880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-554-2600
Provider Business Mailing Address Fax Number:
816-554-2603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 W 135TH ST
Provider Second Line Business Practice Location Address:
SUITE 190B
Provider Business Practice Location Address City Name:
LEAWOOD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66224-8720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-428-8000
Provider Business Practice Location Address Fax Number:
913-428-8001
Provider Enumeration Date:
03/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KUTCH
Authorized Official First Name:
KYLA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CO OWNER
Authorized Official Telephone Number:
913-428-8000

Provider Taxonomy Codes

  • Taxonomy code: 207QS0010X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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