Provider Demographics
NPI:1790701084
Name:HYDE, RITA M (MD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:M
Last Name:HYDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:M
Other - Last Name:MIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2330 SHAWNEE MISSION PKWY
Mailing Address - Street 2:SUITE 2201
Mailing Address - City:WESTWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2005
Mailing Address - Country:US
Mailing Address - Phone:913-588-9800
Mailing Address - Fax:913-588-9803
Practice Address - Street 1:2330 SHAWNEE MISSION PKWY
Practice Address - Street 2:SUITE 2201
Practice Address - City:WESTWOOD
Practice Address - State:KS
Practice Address - Zip Code:66205-2005
Practice Address - Country:US
Practice Address - Phone:913-588-9800
Practice Address - Fax:913-588-9803
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5H43207R00000X
KS04-22238207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203456603Medicaid
MOB940259Medicare ID - Type Unspecified
KSJ610259AMedicare PIN
MO203456603Medicaid