Basic Information
| Provider Information | |||||||||
| NPI: | 1235300344 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHN B. STURGEON M.D. P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 803855 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641803855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9132341350 | ||||||||
| FaxNumber: | 9132341108 | ||||||||
| Practice Location | |||||||||
| Address1: | 8800 W 75TH ST | ||||||||
| Address2: | STE 310 | ||||||||
| City: | SHAWNEE MISSION | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662042205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136717803 | ||||||||
| FaxNumber: | 9137220012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2008 | ||||||||
| LastUpdateDate: | 08/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | STURGEON | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9132341350 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 0423283 | KS | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | DN2011 | 01 | KS | RR MEDICARE | OTHER | 40286019 | 01 | BCBS OF KCMO | OTHER | 424345 | 01 | KS | BCBS OF KS | OTHER | 100159950B | 05 | KS | MEDICAID | 100514 | 01 | KS | BCBS OF GARNETT KS | OTHER |