Basic Information
| Provider Information | |||||||||
| NPI: | 1356347371 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIPS | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9301 W 74TH ST STE 320 | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662042207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134914020 | ||||||||
| FaxNumber: | 9134914725 | ||||||||
| Practice Location | |||||||||
| Address1: | 5525 W. 119TH ST. | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134914020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2005 | ||||||||
| LastUpdateDate: | 03/22/2019 | ||||||||
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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 | 174400000X | 0425627 | KS | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 100174480B | 05 | KS | MEDICAID |