Healthcare Provider Details

I. General information

NPI: 1639719180
Provider Name (Legal Business Name): DYNAMOS ANESTHESIA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 S 4TH ST
LEAVENWORTH KS
66048-5071
US

IV. Provider business mailing address

29800 W 127TH ST
OLATHE KS
66061-8636
US

V. Phone/Fax

Practice location:
  • Phone: 913-680-6000
  • Fax:
Mailing address:
  • Phone: 913-522-0889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: KELLY GORDON
Title or Position: OWNER
Credential: CRNA
Phone: 913-522-0889