Basic Information
Provider Information | |||||||||
NPI: | 1558879320 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | OLATHE HEALTH PHYSICIANS, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | OLATHE HEALTH CARE EXPRESS | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 20333 W 151ST ST | ||||||||
Address2: |   | ||||||||
City: | OLATHE | ||||||||
State: | KS | ||||||||
PostalCode: | 660615350 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9137914200 | ||||||||
FaxNumber: | 9137914458 | ||||||||
Practice Location | |||||||||
Address1: | 830 E MAIN ST | ||||||||
Address2: |   | ||||||||
City: | GARDNER | ||||||||
State: | KS | ||||||||
PostalCode: | 66030 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9133906666 | ||||||||
FaxNumber: | 9138564330 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/16/2018 | ||||||||
LastUpdateDate: | 06/01/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | WIENS | ||||||||
AuthorizedOfficialFirstName: | CATHERINE | ||||||||
AuthorizedOfficialMiddleName: | R. | ||||||||
AuthorizedOfficialTitleorPosition: | VICE PRESIDENT/QUALITY & COMPLIANCE | ||||||||
AuthorizedOfficialTelephone: | 9137914459 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | OLATHE HEALTH PHYSICIANS, INC. | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.