Provider Demographics
NPI:1568544567
Name:MAYOR HEART & LUNG SURGERY OF KANSAS, LLC
Entity Type:Organization
Organization Name:MAYOR HEART & LUNG SURGERY OF KANSAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MAYOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-492-0300
Mailing Address - Street 1:8901 W 74TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2204
Mailing Address - Country:US
Mailing Address - Phone:913-492-0300
Mailing Address - Fax:913-492-0302
Practice Address - Street 1:8901 W 74TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2204
Practice Address - Country:US
Practice Address - Phone:913-492-0300
Practice Address - Fax:913-492-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0426298208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100314130CMedicaid
24951023OtherBCBS OF KANSAS CITY
KSS130000Medicare ID - Type Unspecified
KS100314130CMedicaid