Provider Demographics
NPI:1043736168
Name:POPULUS PHYSICIAN SERVICES, L.L.C.
Entity Type:Organization
Organization Name:POPULUS PHYSICIAN SERVICES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MSHS
Authorized Official - Phone:913-708-1169
Mailing Address - Street 1:PO BOX 8686
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-0686
Mailing Address - Country:US
Mailing Address - Phone:913-708-1169
Mailing Address - Fax:
Practice Address - Street 1:15710 W 135TH ST FL 2
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1511
Practice Address - Country:US
Practice Address - Phone:913-708-1169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty