Provider Demographics
NPI:1417499708
Name:OVERLAND PARK ORTHOPEDICS, LLC
Entity Type:Organization
Organization Name:OVERLAND PARK ORTHOPEDICS, LLC
Other - Org Name:OVERLAND PARK SURGICAL SPECIALISTS & SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LINDSAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-541-5500
Mailing Address - Street 1:12200 W 106TH ST
Mailing Address - Street 2:STE 400
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2305
Mailing Address - Country:US
Mailing Address - Phone:913-541-5500
Mailing Address - Fax:913-541-7474
Practice Address - Street 1:12200 W 106TH ST
Practice Address - Street 2:STE. 400
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2305
Practice Address - Country:US
Practice Address - Phone:913-541-5500
Practice Address - Fax:913-541-7474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01079174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty