Provider Demographics
NPI:1235300344
Name:JOHN B. STURGEON M.D. P.A.
Entity Type:Organization
Organization Name:JOHN B. STURGEON M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:STURGEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-234-1350
Mailing Address - Street 1:PO BOX 803855
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-3855
Mailing Address - Country:US
Mailing Address - Phone:913-234-1350
Mailing Address - Fax:913-234-1108
Practice Address - Street 1:8800 W 75TH ST
Practice Address - Street 2:STE 310
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2205
Practice Address - Country:US
Practice Address - Phone:913-671-7803
Practice Address - Fax:913-722-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0423283207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSDN2011OtherRR MEDICARE
40286019OtherBCBS OF KCMO
KS424345OtherBCBS OF KS
KS100159950BMedicaid
KS100514OtherBCBS OF GARNETT KS
40286019OtherBCBS OF KCMO
MO000A798AMedicare PIN