| Vcphcs Xiv, Llc | |
|
6331 W. 110th Street Overland Park KS 66211 | |
| (913) 696-1911 | |
| (913) 696-1619 |
| Full Name | Vcphcs Xiv, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6331 W. 110th Street, Overland Park, Kansas |
| Authorized Official Name and Position | Jemece Michelle Gasaway (DIRECTOR OF LICENSING) |
| Authorized Official Contact | 2143656126 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vcphcs Xiv, Llc 5001 Spring Valley Road Suite 600 East Dallas TX 75244 Ph: (214) 365-6100 | Vcphcs Xiv, Llc 6331 W. 110th Street Overland Park KS 66211 Ph: (913) 696-1911 |
| NPI Number | 1619313665 |
|---|---|
| Provider Enumeration Date | 05/17/2013 |
| Last Update Date | 02/21/2019 |
| Medicare PECOS PAC ID | 7719288745 |
|---|---|
| Medicare Enrollment ID | O20151217000388 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619313665 | NPI | - | NPPES |
| Provider Name | Iris P Gonzalez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326196718 PECOS PAC ID: 8123930500 Enrollment ID: I20031104000307 |
| Provider Name | Gregory F Lakin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003867953 PECOS PAC ID: 5799699658 Enrollment ID: I20031205000516 |
| Provider Name | Basuviah Shanker |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821055534 PECOS PAC ID: 7315844230 Enrollment ID: I20031217000954 |
| Provider Name | Shawn M Stranckmeyer |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1558776229 PECOS PAC ID: 4688946064 Enrollment ID: I20190506002063 |
| Provider Name | Alicia Bailey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689604944 PECOS PAC ID: 5395758965 Enrollment ID: I20210126001739 |
| Provider Name | Carlos Machicao |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1366401598 PECOS PAC ID: 4981620259 Enrollment ID: I20210715003940 |
| Provider Name | William Carpenter |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164787594 PECOS PAC ID: 9032345400 Enrollment ID: I20210930001224 |
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