Provider Demographics
NPI:1487679098
Name:STATLAND CLINIC LTD
Entity Type:Organization
Organization Name:STATLAND CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-345-8500
Mailing Address - Street 1:5701 WEST 119TH ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3749
Mailing Address - Country:US
Mailing Address - Phone:913-345-8500
Mailing Address - Fax:913-345-3784
Practice Address - Street 1:5701 WEST 119TH ST
Practice Address - Street 2:SUITE 240
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3749
Practice Address - Country:US
Practice Address - Phone:913-345-8500
Practice Address - Fax:913-345-3784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CU0310OtherRAILROAD MEDICARE
KS1002170303AMedicaid
MO1769018OtherBLUE CROSS BLUE SHIELD
CU0310OtherRAILROAD MEDICARE