Provider Demographics
NPI:1497357396
Name:CARBON HEALTH MEDICAL GROUP OF KANSAS PA
Entity Type:Organization
Organization Name:CARBON HEALTH MEDICAL GROUP OF KANSAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-894-1718
Mailing Address - Street 1:10800 SAND HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-6294
Mailing Address - Country:US
Mailing Address - Phone:775-813-4777
Mailing Address - Fax:
Practice Address - Street 1:4817 W 119TH ST STE 120
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-1560
Practice Address - Country:US
Practice Address - Phone:415-200-2002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-15
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care