Provider Demographics
NPI:1659557429
Name:LON C MCCROSKEY MD PA
Entity Type:Organization
Organization Name:LON C MCCROSKEY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LON
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCCROSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-696-1146
Mailing Address - Street 1:5701 W 119TH ST
Mailing Address - Street 2:SUITE 331
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3721
Mailing Address - Country:US
Mailing Address - Phone:913-696-1146
Mailing Address - Fax:913-660-0261
Practice Address - Street 1:5701 W 119TH ST
Practice Address - Street 2:SUITE 331
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3721
Practice Address - Country:US
Practice Address - Phone:913-696-1146
Practice Address - Fax:913-660-0261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0419116174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MON200000AMedicare PIN
KSN200000Medicare PIN