Provider Demographics
NPI:1689772949
Name:SELECT HEALTHCARE PA
Entity Type:Organization
Organization Name:SELECT HEALTHCARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:G
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-948-6400
Mailing Address - Street 1:12140 NALL AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2501
Mailing Address - Country:US
Mailing Address - Phone:913-948-6400
Mailing Address - Fax:913-438-2128
Practice Address - Street 1:12140 NALL AVE STE 305
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2501
Practice Address - Country:US
Practice Address - Phone:913-948-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1679536940OtherDR DAVIS NPI
1740226810OtherROBYN DURST NPI
MO09414045OtherDR. DAVIS BLUE CROSS
MO16807096OtherDR MONACO BLUE CROSS
09414045OtherID
34603019OtherROBYN DURST BLUE CROSS
1942263215OtherDR MONACO NPI
110141836OtherDR DAVIS RAILROAD MEDICAR
1003852187OtherKIMBERLY NAGEL NPI
KSM798976Medicare ID - Type UnspecifiedKIMBERLY NAGEL
1003852187OtherKIMBERLY NAGEL NPI
C52273Medicare UPIN
KSM79D002Medicare ID - Type UnspecifiedROBYN DURST