Provider Demographics
NPI:1598948085
Name:JEANNE E REISS MD PA
Entity Type:Organization
Organization Name:JEANNE E REISS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:REISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-438-2226
Mailing Address - Street 1:PO BOX 14250
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66285-4250
Mailing Address - Country:US
Mailing Address - Phone:913-438-2226
Mailing Address - Fax:913-438-2227
Practice Address - Street 1:373 W 101ST TERR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4408
Practice Address - Country:US
Practice Address - Phone:913-438-2226
Practice Address - Fax:913-438-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR36102084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO03398167OtherBLUE CROSS BLUE SHIELD
MOQ570000Medicare PIN
MOC50629Medicare UPIN
KSQ570000AMedicare PIN
KSQ571470AMedicare PIN
MO03398167OtherBLUE CROSS BLUE SHIELD