| |
15270 W 119th St Olathe KS 66062-5604 | |
(913) 254-0828 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 15270 W 119th St, Olathe, Kansas |
Authorized Official Name and Position | Ken Washington (VP) |
Authorized Official Contact | 9132540918 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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15270 W 119th St Olathe KS 66062-5604 Ph: (913) 254-0828 | 15270 W 119th St Olathe KS 66062-5604 Ph: (913) 254-0828 |
NPI Number | 1477596484 |
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Provider Enumeration Date | 06/14/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1477596484 | NPI | - | NPPES |
20-877559-01 | Medicaid | KS | |
11372027 | Other | MO | BLUE COSS/BLUE SHIELD OF |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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