Basic Information
| Provider Information | |||||||||
| NPI: | 1750374724 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOYACK | ||||||||
| FirstName: | DARREN | ||||||||
| MiddleName: | AMUNDSEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9100 W 74TH ST | ||||||||
| Address2: | |||||||||
| City: | SHAWNEE MISSION | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662044004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136762214 | ||||||||
| FaxNumber: | 9137893106 | ||||||||
| Practice Location | |||||||||
| Address1: | 9100 W 74TH ST | ||||||||
| Address2: | |||||||||
| City: | SHAWNEE MISSION | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662044004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136762214 | ||||||||
| FaxNumber: | 9137893106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2005 | ||||||||
| LastUpdateDate: | 06/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 0431179 | KS | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200346760B | 05 | KS | MEDICAID | P00263567 | 01 | RR MEDICARE GROUP CG8899 | OTHER | 01674018 | 01 | BCBS KCMO GROUP 01674018 | OTHER | 207449406 | 05 | MO | MEDICAID | 200346760A | 05 | KS | MEDICAID | 35924016 | 01 | BCBS OF KC MO | OTHER | 35924036 | 01 | KS | BCBS KCMO GROUP 01674018 | OTHER | P00291773 | 01 | RR MEDICARE GROUP DC6712 | OTHER |