Provider Demographics
NPI:1952385379
Name:ABB PA
Entity Type:Organization
Organization Name:ABB PA
Other - Org Name:ABB INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROWLETT
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA MS
Authorized Official - Phone:913-268-4133
Mailing Address - Street 1:PO BOX 25097
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66225-5097
Mailing Address - Country:US
Mailing Address - Phone:913-268-4133
Mailing Address - Fax:913-268-4138
Practice Address - Street 1:918 HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-8885
Practice Address - Country:US
Practice Address - Phone:620-223-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSDA2652OtherRAILROAD MEDICARE
MO33139012OtherBLUE CROSS BLUE SHIELD
KS180635OtherBLUE CROSS BLUE SHIELD
MODA2653OtherRAILROAD MEDICARE
KS180635Medicare PIN
MO33139012OtherBLUE CROSS BLUE SHIELD