Provider Demographics
NPI:1528024676
Name:KANSAS CITY UROLOGY CARE, P.A.
Entity Type:Organization
Organization Name:KANSAS CITY UROLOGY CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:913-341-7733
Mailing Address - Street 1:8551 BLUEJACKET ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1656
Mailing Address - Country:US
Mailing Address - Phone:913-341-7985
Mailing Address - Fax:913-341-7988
Practice Address - Street 1:10701 NALL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1231
Practice Address - Country:US
Practice Address - Phone:913-341-7985
Practice Address - Fax:913-341-7988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100361650AMedicaid
MO505100305Medicaid
MO505100800Medicaid
KS100361350BMedicaid
MO505100800Medicaid
KS100361650AMedicaid
KS100361350BMedicaid
KS110496Medicare PIN
MOJ710000AMedicare ID - Type Unspecified