Provider Demographics
NPI:1033457460
Name:OZ LC
Entity Type:Organization
Organization Name:OZ LC
Other - Org Name:OZ LC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-450-7488
Mailing Address - Street 1:10630B METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-1816
Mailing Address - Country:US
Mailing Address - Phone:913-871-8785
Mailing Address - Fax:913-652-6868
Practice Address - Street 1:10630B METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1816
Practice Address - Country:US
Practice Address - Phone:913-871-8785
Practice Address - Fax:913-652-6868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01269352083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS48057016OtherBCBS OF KC