Basic Information
| Provider Information | |||||||||
| NPI: | 1538141353 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERRILL | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | P. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10301 HICKMAN MILLS DR | ||||||||
| Address2: | 100 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641371674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167635446 | ||||||||
| FaxNumber: | 8167638426 | ||||||||
| Practice Location | |||||||||
| Address1: | 10500 QUIVIRA RD | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662152306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167635446 | ||||||||
| FaxNumber: | 8167638426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2005 | ||||||||
| LastUpdateDate: | 09/22/2010 | ||||||||
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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 | 207L00000X | 2004007002 | MO | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 04-30585 | KS | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 49058 | CO | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 209272608 | 05 | MO | MEDICAID | 00908037 | 05 | CO | MEDICAID | 200267240A | 05 | KS | MEDICAID |