Provider Demographics
NPI:1710934245
Name:MONARCH PLASTIC SURGERY P A
Entity Type:Organization
Organization Name:MONARCH PLASTIC SURGERY P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-663-3838
Mailing Address - Street 1:4801 W 135TH ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66224-8901
Mailing Address - Country:US
Mailing Address - Phone:913-663-3838
Mailing Address - Fax:913-663-4434
Practice Address - Street 1:4801 W 135TH ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66224-8901
Practice Address - Country:US
Practice Address - Phone:913-663-3838
Practice Address - Fax:913-663-4434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-29
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110959Medicare PIN
MOG390000AMedicare PIN
KSG390000Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER