Provider Demographics
NPI:1336269570
Name:ORTHOPAEDIC & SPORTS MEDICINE CLINIC OF KANSAS CITY, LLC
Entity Type:Organization
Organization Name:ORTHOPAEDIC & SPORTS MEDICINE CLINIC OF KANSAS CITY, LLC
Other - Org Name:ORTHOPAEDIC & SPORTS MEDICINE CLINIC OF KANSAS CITY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:E
Authorized Official - Last Name:BROWNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-319-7546
Mailing Address - Street 1:3651 COLLEGE BLVD
Mailing Address - Street 2:#100A
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1904
Mailing Address - Country:US
Mailing Address - Phone:913-319-7546
Mailing Address - Fax:913-319-7691
Practice Address - Street 1:3651 COLLEGE BLVD
Practice Address - Street 2:#100A
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1904
Practice Address - Country:US
Practice Address - Phone:913-319-7546
Practice Address - Fax:913-319-7691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0416972207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS504394OtherBLUE CROSS BLUE SHIELD
17283059OtherBLUE CROSS BLUE SHIELD
KS497571OtherBLUE CROSS BLUE SHIELD
06545035OtherBLUE CROSS BLUE SHIELD
14161075OtherBLUE CROSS BLUE SHIELD
KS76769OtherBLUE CROSS BLUE SHIELD
0142479Medicare ID - Type Unspecified
14161075OtherBLUE CROSS BLUE SHIELD
17283059OtherBLUE CROSS BLUE SHIELD
E19467Medicare UPIN
C50313Medicare UPIN
0140007Medicare ID - Type Unspecified
E04987Medicare UPIN