1568544567 NPI number — MAYOR HEART & LUNG SURGERY OF KANSAS, LLC

Table of content: (NPI 1568544567)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568544567 NPI number — MAYOR HEART & LUNG SURGERY OF KANSAS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAYOR HEART & LUNG SURGERY OF KANSAS, 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:
1568544567
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2010
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:
SUITE 1
Provider Business Mailing Address City Name:
SHAWNEE MISSION
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:
913-492-0300
Provider Business Mailing Address Fax Number:
913-492-0302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8901 W 74TH ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
SHAWNEE MISSION
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:
913-492-0300
Provider Business Practice Location Address Fax Number:
913-492-0302
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAYOR
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
913-492-0300

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  0426298 , 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)

  • Identifier: 100314130C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 24951023 . This is a "BCBS OF KANSAS CITY" identifier . This identifiers is of the category "OTHER".




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