1528024676 NPI number — KANSAS CITY UROLOGY CARE, P.A.

Table of content: (NPI 1528024676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528024676 NPI number — KANSAS CITY UROLOGY CARE, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KANSAS CITY UROLOGY CARE, P.A.
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:
1528024676
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8551 BLUEJACKET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LENEXA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66214-1656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-341-7985
Provider Business Mailing Address Fax Number:
913-341-7988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10701 NALL AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66211-1231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-341-7985
Provider Business Practice Location Address Fax Number:
913-341-7988
Provider Enumeration Date:
04/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BURNETT
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
H
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
913-341-7733

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100361650A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 505100305 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 505100800 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100361350B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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