Basic Information
| Provider Information | |||||||||
| NPI: | 1851463624 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OLATHE CANCER CARE, P.A. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | DAVID L. LEE, MD | ||||||||
| OtherOrganizationType: | 4 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 20375 W 151ST ST | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660617218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137804000 | ||||||||
| FaxNumber: | 9137804038 | ||||||||
| Practice Location | |||||||||
| Address1: | 20375 W 151ST ST | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660617218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137804000 | ||||||||
| FaxNumber: | 9137804038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 07/11/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SCHMIDT | ||||||||
| AuthorizedOfficialFirstName: | MELODIE | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9137804000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 0430533 | KS | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Specialist | 174400000X | 0420572 | KS | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 100208120A | 05 | KS | MEDICAID | 200266340A | 05 | KS | MEDICAID | 200266330A | 05 | KS | MEDICAID | 34068015 | 01 | KS | BC OF KANSAS CITY | OTHER | 622146 | 01 | KS | BC OF KANSAS | OTHER | 13873018 | 01 | KS | BC OF KANSAS CITY | OTHER |