Basic Information
Provider Information
NPI: 1285166199
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROONEY
FirstName: ANTHONY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2330 SHAWNEE MISSION PKWY STE 210
Address2:  
City: WESTWOOD
State: KS
PostalCode: 662052005
CountryCode: US
TelephoneNumber: 9035880348
FaxNumber: 9135884085
Practice Location
Address1: 2650 SHAWNEE MISSION PKWY
Address2:  
City: WESTWOOD
State: KS
PostalCode: 662052003
CountryCode: US
TelephoneNumber: 9135880348
FaxNumber: 9135884035
Other Information
ProviderEnumerationDate: 03/30/2017
LastUpdateDate: 07/11/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/11/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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