COLLEGE PARK FAMILY CARE CENTER PA NPI 1740248772

NPI Information

NPI: 1740248772
Provider Name: COLLEGE PARK FAMILY CARE CENTER PA
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 17D2266539

Address:
11755 W 112TH ST
SUITE 101
OVERLAND PARK, KS
ZIP 66210
Phone: (913) 469-0503
Get Directions

COLLEGE PARK FAMILY CARE CENTER PA is a family medicine in Overland Park, KS. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. COLLEGE PARK FAMILY CARE CENTER PA NPI is 1740248772. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

11755 W 112TH ST
SUITE 101
OVERLAND PARK, KS
ZIP 66210-761
Phone: (913) 469-0503
Fax: (913) 338-1311

The provider's authorized official is Chuck O. Chambers .
The authorized official title is Administrator and has the following contact phone number (913) 469-0503.

The CLIA number assigned to this NPI record is 17D2266539 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/1/2006 and was last updated on 3/26/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	207K00000X	Allergy & Immunology		No
2	207N00000X	Dermatology		No
3	207Y00000X	Otolaryngology		No
4	2081P2900X	Physical Medicine & Rehabilitation	Pain Medicine	No
5	208800000X	Urology		No
6	2084N0400X	Psychiatry & Neurology	Neurology	No
7	208600000X	Surgery		No
8	207V00000X	Obstetrics & Gynecology		No
9	207X00000X	Orthopaedic Surgery		No
10	207Q00000X	Family Medicine		Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	5530000A	MEDICARE ID-TYPE UNSPECIFIED	KANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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