Basic Information
Provider Information | |||||||||
NPI: | 1255974929 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HEALTH PARTNERSHIP CLINIC, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | HEALTH PARTNERSHIP CLINIC - OLATHE NORTH HIGH SCHOOL | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 405 S CLAIRBORNE RD STE 2 | ||||||||
Address2: |   | ||||||||
City: | OLATHE | ||||||||
State: | KS | ||||||||
PostalCode: | 660621774 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9136482266 | ||||||||
FaxNumber: | 9137681944 | ||||||||
Practice Location | |||||||||
Address1: | 600 E PRAIRIE ST | ||||||||
Address2: |   | ||||||||
City: | OLATHE | ||||||||
State: | KS | ||||||||
PostalCode: | 660613355 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9136482266 | ||||||||
FaxNumber: | 9137681944 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/24/2019 | ||||||||
LastUpdateDate: | 03/23/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | REESE-TURNER | ||||||||
AuthorizedOfficialFirstName: | BILLIE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | DIRECTOR OF BILLING & PATIENT SVCS | ||||||||
AuthorizedOfficialTelephone: | 9137303674 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | HEALTH PARTNERSHIP CLINIC, INC. | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/23/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
ID | Type | State | Issuer | Description | 200852450L | 05 | KS |   | MEDICAID |