Provider Demographics
NPI:1093739732
Name:PAIGE, DICKY LEE (PA)
Entity Type:Individual
Prefix:
First Name:DICKY
Middle Name:LEE
Last Name:PAIGE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2337 G ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BELLEVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66935-2463
Mailing Address - Country:US
Mailing Address - Phone:785-527-2237
Mailing Address - Fax:785-527-2820
Practice Address - Street 1:2337 G ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BELLEVILLE
Practice Address - State:KS
Practice Address - Zip Code:66935-2463
Practice Address - Country:US
Practice Address - Phone:785-527-2237
Practice Address - Fax:785-527-2820
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00378363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS023170OtherBLUECROSS BLUE SHIELD KS
KS023170Medicare ID - Type Unspecified
KSR32038Medicare UPIN