Provider Demographics
NPI:1629119011
Name:JAMES A DAVIDSON MD PC
Entity Type:Organization
Organization Name:JAMES A DAVIDSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERPHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-451-7350
Mailing Address - Street 1:5701 W 119 ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3722
Mailing Address - Country:US
Mailing Address - Phone:913-451-7350
Mailing Address - Fax:913-345-2339
Practice Address - Street 1:5701 W 119 ST
Practice Address - Street 2:SUITE 220
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3722
Practice Address - Country:US
Practice Address - Phone:913-451-7350
Practice Address - Fax:913-345-2339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0424350208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
16268020OtherBLUECROSSBLUESHIELD
KS100158020AMedicaid
19438017OtherBLUECROSSBLUESHIELD
MO203025408Medicaid
19438017OtherBLUECROSSBLUESHIELD
KS100158020AMedicaid
MO203025408Medicaid