Basic Information
| Provider Information | |||||||||
| NPI: | 1790155158 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHERIDAN EMERGENCY PHYSICIAN SERVICES OF KANSAS, PA | ||||||||
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| Address1: | PO BOX 453548 | ||||||||
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| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333453548 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 8929 PARALLEL PKWY | ||||||||
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| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 661121689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135964862 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2015 | ||||||||
| LastUpdateDate: | 01/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | ANDRULONIS | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9548382371 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.