Basic Information
Provider Information | |||||||||
NPI: | 1154577914 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | EICKMEYER | ||||||||
FirstName: | SARAH | ||||||||
MiddleName: | MARIA | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | LAABS | ||||||||
OtherFirstName: | SARAH | ||||||||
OtherMiddleName: | MARIA | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 3901 RAINBOW BLVD | ||||||||
Address2: | PHYSICAL MEDICINE AND REHABILITATION | ||||||||
City: | KANSAS CITY | ||||||||
State: | KS | ||||||||
PostalCode: | 661608500 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9135886944 | ||||||||
FaxNumber: | 9135886765 | ||||||||
Practice Location | |||||||||
Address1: | 3901 RAINBOW BLVD | ||||||||
Address2: | PHYSICAL MEDICINE AND REHABILITATION | ||||||||
City: | KANSAS CITY | ||||||||
State: | KS | ||||||||
PostalCode: | 661608500 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9135886944 | ||||||||
FaxNumber: | 9135886765 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/13/2008 | ||||||||
LastUpdateDate: | 07/13/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 125-052792 | IL | N |   | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |   | 208100000X | 55579 | WI | N |   | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |   | 208100000X | 0437648 | KS | Y |   | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |   |
ID Information
ID | Type | State | Issuer | Description | 1154577914 | 05 | WI |   | MEDICAID |