Provider Demographics
NPI:1932157799
Name:COMPREHENSIVE SENIOR SERVICES P.A.
Entity Type:Organization
Organization Name:COMPREHENSIVE SENIOR SERVICES P.A.
Other - Org Name:MARY ANN LILLIG, D.O.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:LILLIG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-668-4297
Mailing Address - Street 1:PO BOX 419429
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-6429
Mailing Address - Country:US
Mailing Address - Phone:913-248-9693
Mailing Address - Fax:913-248-9383
Practice Address - Street 1:14583 GRANADA CIR
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66224-3701
Practice Address - Country:US
Practice Address - Phone:816-668-4297
Practice Address - Fax:913-239-8702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999-135-661207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO36947011OtherBLUE SHIELD KC, MO
KSDD4155OtherRAILROAD MEDICARE
MO36947011OtherBLUE SHIELD KC, MO
KSW180000Medicare PIN