Provider Demographics
NPI:1356533913
Name:MILBURN MEDICAL LLC
Entity type:Organization
Organization Name:MILBURN MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILBURN
Authorized Official - Suffix:
Authorized Official - Credentials:CPED COF
Authorized Official - Phone:913-341-8222
Mailing Address - Street 1:9303 W 75TH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2234
Mailing Address - Country:US
Mailing Address - Phone:913-341-8222
Mailing Address - Fax:913-341-8272
Practice Address - Street 1:9303 W 75TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-2234
Practice Address - Country:US
Practice Address - Phone:913-341-8222
Practice Address - Fax:913-341-8272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS004-F-01332BC3200X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS35093021OtherBCBS OF KANSAS CITY
KS5986580001Medicare NSC