Basic Information
| Provider Information | |||||||||
| NPI: | 1407040967 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OVERLAND PARK MEDICAL SPECIALISTS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10550 QUIVIRA RD | ||||||||
| Address2: | SUITE 530 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662152306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135993828 | ||||||||
| FaxNumber: | 9135993451 | ||||||||
| Practice Location | |||||||||
| Address1: | 10550 QUIVIRA RD | ||||||||
| Address2: | SUITE 530 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662152306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135993828 | ||||||||
| FaxNumber: | 9135993451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2007 | ||||||||
| LastUpdateDate: | 03/24/2009 | ||||||||
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| AuthorizedOfficialLastName: | KUENY | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 9135993828 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 04-28969 | KS | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 200517020A | 05 | KS | MEDICAID | 507018208 | 05 | MO | MEDICAID |