Provider Demographics
NPI:1629244314
Name:MARIA JAVAID MD AN OPERATING DIVISION OF PROVIDENCE MEDICAL CTR
Entity Type:Organization
Organization Name:MARIA JAVAID MD AN OPERATING DIVISION OF PROVIDENCE MEDICAL CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-596-4000
Mailing Address - Street 1:PO BOX 12143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-0143
Mailing Address - Country:US
Mailing Address - Phone:913-596-6512
Mailing Address - Fax:913-328-7011
Practice Address - Street 1:712 1ST TER
Practice Address - Street 2:SUITE C
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-1735
Practice Address - Country:US
Practice Address - Phone:913-682-6950
Practice Address - Fax:913-682-8523
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROVIDENCE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty