Provider Demographics
NPI:1275857575
Name:E KENT STEVENSON MD PC
Entity Type:Organization
Organization Name:E KENT STEVENSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-649-5567
Mailing Address - Street 1:5200 W 94TH TER
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66207-2522
Mailing Address - Country:US
Mailing Address - Phone:913-649-5567
Mailing Address - Fax:913-649-7563
Practice Address - Street 1:5200 W 94TH TER
Practice Address - Street 2:SUITE 105
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66207-2522
Practice Address - Country:US
Practice Address - Phone:913-649-5567
Practice Address - Fax:913-649-7563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04157892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS04563147OtherBLUE CROSS BLUE SHIELD
KS04563147OtherBLUE CROSS BLUE SHIELD