Provider Demographics
NPI:1972543494
Name:TOWN PLAZA FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:TOWN PLAZA FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUENY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-345-3650
Mailing Address - Street 1:5701 W 119TH ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3722
Mailing Address - Country:US
Mailing Address - Phone:913-345-3650
Mailing Address - Fax:
Practice Address - Street 1:5701 W 119TH ST
Practice Address - Street 2:SUITE 410
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3722
Practice Address - Country:US
Practice Address - Phone:913-345-3650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO23902020OtherBCBS OF KC
MO506089606Medicaid
KS100453440AMedicaid
MO23902020OtherBCBS OF KC
KSDA1341Medicare ID - Type UnspecifiedRR MEDICARE