Provider Demographics
NPI:1821286642
Name:JASON WILTSHIRE, MD, PA
Entity Type:Organization
Organization Name:JASON WILTSHIRE, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:WILTSHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-315-7874
Mailing Address - Street 1:8919 PARALLEL PKWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-1636
Mailing Address - Country:US
Mailing Address - Phone:417-825-8300
Mailing Address - Fax:501-778-5993
Practice Address - Street 1:8919 PARALLEL PKWY
Practice Address - Street 2:SUITE 206
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1636
Practice Address - Country:US
Practice Address - Phone:417-825-8300
Practice Address - Fax:501-778-5993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3347174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR146948001Medicaid
AR146948001Medicaid
ARH25806Medicare UPIN