Healthcare Provider Details

I. General information

NPI: 1588848352
Provider Name (Legal Business Name): CAH ACQUISITION COMPANY 3 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 MAIN ST
EVEREST KS
66424-9157
US

IV. Provider business mailing address

1100 MAIN ST SUITE 2350
KANSAS CITY MO
64105-2120
US

V. Phone/Fax

Practice location:
  • Phone: 785-548-7610
  • Fax: 785-486-2842
Mailing address:
  • Phone: 785-486-2642
  • Fax: 785-486-2842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH-007-002
License Number StateKS

VIII. Authorized Official

Name: TERRY W NICHOLS
Title or Position: CEO
Credential:
Phone: 785-486-2642