Provider Demographics
NPI:1902224504
Name:LORI ANN GOLON, M.D.
Entity Type:Organization
Organization Name:LORI ANN GOLON, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GOLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-682-3920
Mailing Address - Street 1:1001 6TH AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-3222
Mailing Address - Country:US
Mailing Address - Phone:913-682-3920
Mailing Address - Fax:913-682-6239
Practice Address - Street 1:1001 6TH AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-3222
Practice Address - Country:US
Practice Address - Phone:913-682-3920
Practice Address - Fax:913-682-6239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-01
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0428097302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1114019593Medicaid
KS1629160007Medicaid