Provider Demographics
NPI:1063457299
Name:ENCOMPASS MEDICAL GROUP, PA
Entity Type:Organization
Organization Name:ENCOMPASS MEDICAL GROUP, PA
Other - Org Name:ENCOMPASS MEDICAL GROUP, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAYNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HODGDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-495-2046
Mailing Address - Street 1:8550 MARSHALL DR
Mailing Address - Street 2:SUITE 220 ADMINISTRATION
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1505
Mailing Address - Country:US
Mailing Address - Phone:913-495-2000
Mailing Address - Fax:913-495-2201
Practice Address - Street 1:8550 MARSHALL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214-1505
Practice Address - Country:US
Practice Address - Phone:913-495-2000
Practice Address - Fax:913-273-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOK670000Medicare ID - Type Unspecified
KSK670000AMedicare ID - Type Unspecified