Basic Information
| Provider Information | |||||||||
| NPI: | 1265489017 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBINSON | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | N. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2330 SHAWNEE MISSION PKWY | ||||||||
| Address2: | MEDICAL ADMINISTRATIVE SERVICES OF KU MED, STE. 312 | ||||||||
| City: | WESTWOOD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662052005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135889000 | ||||||||
| FaxNumber: | 9135889822 | ||||||||
| Practice Location | |||||||||
| Address1: | 7405 RENNER RD | ||||||||
| Address2: | KU MEDWEST AFTER HOURS / URGENT CARE | ||||||||
| City: | SHAWNEE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662179414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135888450 | ||||||||
| FaxNumber: | 9135888423 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 06/09/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 04-27493 | KS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 04-27493 | KS | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 25562039 | 01 | BCBS PROVIDER NUMBER | OTHER | 3684262 | 01 | AETNA PROVIDER NUMBER | OTHER | 10001781300 | 01 | CHP PROVIDER NUMBR | OTHER | 100361490B | 05 | KS | MEDICAID | 481159444 | 01 | JAYHAWK TAX ID | OTHER | 406520 | 01 | FIRSTGUARD PROVIDER NUMBE | OTHER |