Provider Demographics
NPI:1790794089
Name:FAMILY PRACTICE ASSOCIATES CHTD
Entity Type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES CHTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICENTE
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:PALMERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-299-2100
Mailing Address - Street 1:PO BOX 12066
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-0066
Mailing Address - Country:US
Mailing Address - Phone:913-299-4966
Mailing Address - Fax:913-299-4205
Practice Address - Street 1:1150 N 75TH PL
Practice Address - Street 2:SUITE 200
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-3302
Practice Address - Country:US
Practice Address - Phone:913-299-2100
Practice Address - Fax:913-299-4205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSC470000OtherMEDICARE PTAN
KSC470000AOtherMEDICARE PTAN
KS100289320BMedicaid
KS100289320AMedicaid
KSC470000AOtherMEDICARE PTAN
KS100289320BMedicaid