Provider Demographics
NPI:1225336597
Name:PRIMARY CARE PLUS OF LEAWOOD LLC
Entity Type:Organization
Organization Name:PRIMARY CARE PLUS OF LEAWOOD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ETHAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:913-428-8000
Mailing Address - Street 1:4900 W 135TH ST
Mailing Address - Street 2:SUITE 190A
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66224-8900
Mailing Address - Country:US
Mailing Address - Phone:913-428-8000
Mailing Address - Fax:913-428-8001
Practice Address - Street 1:4900 W 135TH ST
Practice Address - Street 2:SUITE 190A
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66224-8900
Practice Address - Country:US
Practice Address - Phone:913-428-8000
Practice Address - Fax:913-428-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty