Provider Demographics
NPI:1811924780
Name:CHARLES I DAVIS MD PA
Entity type:Organization
Organization Name:CHARLES I DAVIS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ISAAC
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-648-8880
Mailing Address - Street 1:9250 GLENWOOD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-1365
Mailing Address - Country:US
Mailing Address - Phone:913-648-8880
Mailing Address - Fax:913-648-8881
Practice Address - Street 1:9250 GLENWOOD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1365
Practice Address - Country:US
Practice Address - Phone:913-648-8880
Practice Address - Fax:913-648-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0429493207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOR280000AMedicare PIN
KSR280000Medicare PIN
KSH87999Medicare UPIN
KS111023Medicare PIN
DB1897Medicare PIN