Provider Demographics
NPI:1871740464
Name:PHYSICIAN ASSOCIATES OF CORPORATE WOODS, LLC
Entity type:Organization
Organization Name:PHYSICIAN ASSOCIATES OF CORPORATE WOODS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUENY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-508-4090
Mailing Address - Street 1:8675 COLLEGE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1835
Mailing Address - Country:US
Mailing Address - Phone:913-327-0911
Mailing Address - Fax:913-327-0912
Practice Address - Street 1:8675 COLLEGE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1835
Practice Address - Country:US
Practice Address - Phone:913-327-0911
Practice Address - Fax:913-327-0912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1871740464Medicaid
KS200584180 AMedicaid
KS200584180 AMedicaid
KSDO3970Medicare PIN