1831153204 NPI number — MARY C OCONNOR MD

Table of content: MARY C OCONNOR MD (NPI 1831153204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831153204 NPI number — MARY C OCONNOR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OCONNOR
Provider First Name:
MARY
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1831153204
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4601 W 109TH ST STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66211-1313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-942-0540
Provider Business Mailing Address Fax Number:
630-528-9589

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 NE 54TH ST
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64118-4389
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-799-0180
Provider Business Practice Location Address Fax Number:
630-528-9579
Provider Enumeration Date:
04/13/2006

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: 207RI0200X , with the licence number:  04-22252 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X , with the licence number: R3K61 , 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)





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