Provider Demographics
NPI:1972656528
Name:JAMES MIRABILE MD PA
Entity Type:Organization
Organization Name:JAMES MIRABILE MD PA
Other - Org Name:FOR WOMEN ONLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-541-9495
Mailing Address - Street 1:1262 W AMITY ST
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66053-7815
Mailing Address - Country:US
Mailing Address - Phone:913-837-3199
Mailing Address - Fax:
Practice Address - Street 1:10600 QUIVIRA RD
Practice Address - Street 2:SUITE 110
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2309
Practice Address - Country:US
Practice Address - Phone:913-541-9495
Practice Address - Fax:913-438-8410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSF840000Medicare ID - Type Unspecified