Provider Demographics
NPI:1275633497
Name:LEAWOOD FAMILY CARE, PA
Entity Type:Organization
Organization Name:LEAWOOD FAMILY CARE, PA
Other - Org Name:LEAWOOD FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-338-4515
Mailing Address - Street 1:11301 ASH ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1643
Mailing Address - Country:US
Mailing Address - Phone:913-338-4515
Mailing Address - Fax:913-338-4606
Practice Address - Street 1:11301 ASH ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211
Practice Address - Country:US
Practice Address - Phone:913-338-4515
Practice Address - Fax:913-338-4606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS78221207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO31255011OtherBCBS OF KANSAS CITY GROUP
MO31255011OtherBCBS OF KANSAS CITY GROUP