Provider Demographics
NPI:1053310938
Name:STEPHENS, THAD A (MD)
Entity Type:Individual
Prefix:
First Name:THAD
Middle Name:A
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 CARONDELET DR STE 200
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4698
Mailing Address - Country:US
Mailing Address - Phone:816-943-5690
Mailing Address - Fax:816-943-3156
Practice Address - Street 1:930 CARONDELET DR STE 200
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4698
Practice Address - Country:US
Practice Address - Phone:816-943-5690
Practice Address - Fax:816-943-3156
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102147207P00000X, 2083P0011X, 207PE0005X
KS04-29528207PE0005X, 207PE0004X
MOMD102147207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100174340HMedicaid
KS100174340GMedicaid
18933052OtherBLUE CROSS BLUE SHIELD