Provider Demographics
NPI:1417004300
Name:HENDERSON, SCOTT JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JAMES
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8717 W 110TH ST
Mailing Address - Street 2:BLDG 14, STE 600
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2144
Mailing Address - Country:US
Mailing Address - Phone:913-428-2900
Mailing Address - Fax:913-428-2951
Practice Address - Street 1:OVERLAND PARK REG. MED CENTER, DEPT. OF ANESTHESIOLOGY
Practice Address - Street 2:10500 QUIVIRA ROAD
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215
Practice Address - Country:US
Practice Address - Phone:313-428-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007013970207L00000X
KS04-32460207L00000X
TNMD0000040132207L00000X
NE26906207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200443340AMedicaid
MO204466601Medicaid
KS013F405Medicare PIN