Basic Information
| Provider Information | |||||||||
| NPI: | 1073595898 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTH CARE ASSOCIATED EMERGENCY PHYSICIANS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 838 | ||||||||
| Address2: | |||||||||
| City: | SHAWNEE MISSION | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662010838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134694244 | ||||||||
| FaxNumber: | 9134691939 | ||||||||
| Practice Location | |||||||||
| Address1: | 10975 BENSON ST | ||||||||
| Address2: | 12 CORPORATE WOODS SUITE 250 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662101534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134694244 | ||||||||
| FaxNumber: | 9134691939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2005 | ||||||||
| LastUpdateDate: | 03/09/2012 | ||||||||
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| AuthorizedOfficialLastName: | ROOT | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATIVE ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 9134691488 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200356840B | 05 | KS | MEDICAID | 509033908 | 05 | MO | MEDICAID |