Provider Demographics
NPI:1770605297
Name:ENCOMPASS MEDICAL GROUP, PA
Entity type:Organization
Organization Name:ENCOMPASS MEDICAL GROUP, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAYNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HODGDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-495-2046
Mailing Address - Street 1:8550 MARSHALL DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1505
Mailing Address - Country:US
Mailing Address - Phone:913-495-2220
Mailing Address - Fax:913-273-1153
Practice Address - Street 1:373 W 101ST TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4408
Practice Address - Country:US
Practice Address - Phone:816-942-8200
Practice Address - Fax:816-942-0531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA261QU0200X
2085R0202X, 208000000X, 208D00000X, 207Q00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
261QUO200XCLINICOtherTAXONOMY CODE