Basic Information
| Provider Information | |||||||||
| NPI: | 1881811602 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WAIT | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RIDDEN | ||||||||
| OtherFirstName: | AMANDA | ||||||||
| OtherMiddleName: | G | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 901 E. 104TH ST | ||||||||
| Address2: | MAILSTOP 400N | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641319712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165027104 | ||||||||
| FaxNumber: | 8169329670 | ||||||||
| Practice Location | |||||||||
| Address1: | 2737 NE MCBAINE DR | ||||||||
| Address2: | |||||||||
| City: | LEES SUMMIT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640647880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162515780 | ||||||||
| FaxNumber: | 8162515781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2007 | ||||||||
| LastUpdateDate: | 02/27/2018 | ||||||||
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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 | 207V00000X | OS10917 | FL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 2011016772 | MO | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 46070012 | 01 | MO | BCBS OF KC | OTHER | 598858 | 01 | MO | COVENTRY HEALTHCARE OF KANSAS | OTHER | 746460 | 01 | MO | MISSOURI CARE | OTHER | 1881811602 | 05 | MO | MEDICAID | 0904564 | 01 | MO | CIGNA | OTHER |