Provider Demographics
NPI:1376619635
Name:GERHARD W CIBIS MD PC
Entity Type:Organization
Organization Name:GERHARD W CIBIS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENEANE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-491-0765
Mailing Address - Street 1:4620 J C NICHOLS PKWY
Mailing Address - Street 2:421
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-1617
Mailing Address - Country:US
Mailing Address - Phone:816-561-0306
Mailing Address - Fax:816-531-7166
Practice Address - Street 1:4620 J C NICHOLS PKWY
Practice Address - Street 2:421
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1617
Practice Address - Country:US
Practice Address - Phone:816-561-0306
Practice Address - Fax:816-531-7166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO08196015OtherBLUE CROSS BLUE SHIELD
MOK710000Medicare ID - Type Unspecified