Provider Demographics
NPI:1356374805
Name:CARONDELET ORTHOPAEDIC SURGEONS PA
Entity type:Organization
Organization Name:CARONDELET ORTHOPAEDIC SURGEONS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HEALY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-642-0200
Mailing Address - Street 1:10777 NALL AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1231
Mailing Address - Country:US
Mailing Address - Phone:913-642-0200
Mailing Address - Fax:913-563-6699
Practice Address - Street 1:10777 NALL AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1231
Practice Address - Country:US
Practice Address - Phone:913-642-0200
Practice Address - Fax:913-563-6699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0430917208100000X
KS0418120207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSCP4234Medicare PIN
MO2820000Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
KS2820000AMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER