Provider Demographics
NPI:1205930419
Name:JAMES MIRABILE MD PA
Entity type:Organization
Organization Name:JAMES MIRABILE MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCANALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-541-5231
Mailing Address - Street 1:4550 W 109TH ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1360
Mailing Address - Country:US
Mailing Address - Phone:913-888-7546
Mailing Address - Fax:913-338-1337
Practice Address - Street 1:4550 W 109TH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1360
Practice Address - Country:US
Practice Address - Phone:913-888-7546
Practice Address - Fax:913-338-1337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO501535900Medicaid
KSF840000Medicare ID - Type Unspecified