Provider Demographics
NPI:1447287776
Name:JOHNSON COUNTY SPINE, P.A
Entity type:Organization
Organization Name:JOHNSON COUNTY SPINE, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:A
Authorized Official - Last Name:HESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-491-3344
Mailing Address - Street 1:8575 W 110TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1865
Mailing Address - Country:US
Mailing Address - Phone:913-491-3344
Mailing Address - Fax:913-491-3345
Practice Address - Street 1:8575 W 110TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1865
Practice Address - Country:US
Practice Address - Phone:913-491-3344
Practice Address - Fax:913-491-3345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSS580000Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
KS5766450001Medicare NSC