Provider Demographics
NPI:1770522641
Name:OVERLAND PARK CARDIOVASCULAR, INC.
Entity type:Organization
Organization Name:OVERLAND PARK CARDIOVASCULAR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUENY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-227-0506
Mailing Address - Street 1:12200 W 106TH ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2300
Mailing Address - Country:US
Mailing Address - Phone:913-227-0506
Mailing Address - Fax:
Practice Address - Street 1:12200 W 106TH ST
Practice Address - Street 2:SUITE 320
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2300
Practice Address - Country:US
Practice Address - Phone:913-227-0506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200269920AMedicaid
MO508337706Medicaid
KS200269920AMedicaid