Provider Demographics
NPI:1790853968
Name:PULMONARY MEDICINE ASSOC P C
Entity Type:Organization
Organization Name:PULMONARY MEDICINE ASSOC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOTTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-432-8000
Mailing Address - Street 1:8901 W 74TH ST
Mailing Address - Street 2:#348
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2204
Mailing Address - Country:US
Mailing Address - Phone:913-432-8000
Mailing Address - Fax:913-432-3144
Practice Address - Street 1:8901 W 74TH ST
Practice Address - Street 2:#348
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-2204
Practice Address - Country:US
Practice Address - Phone:913-432-8000
Practice Address - Fax:913-432-3144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0418793207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5150000BMedicare ID - Type Unspecified
KS5150000AMedicare ID - Type Unspecified