Provider Demographics
NPI:1457183469
Name:OVERLAND PARK MEDICAL CENTER LLC
Entity type:Organization
Organization Name:OVERLAND PARK MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASTON
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSWORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MSN, FNP-BC
Authorized Official - Phone:816-674-2693
Mailing Address - Street 1:8809 SE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-7858
Mailing Address - Country:US
Mailing Address - Phone:816-674-2693
Mailing Address - Fax:816-229-7085
Practice Address - Street 1:10520 BARKLEY ST STE 120
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1823
Practice Address - Country:US
Practice Address - Phone:816-229-1941
Practice Address - Fax:816-229-7085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care