Healthcare Provider Details

I. General information

NPI: 1225336597
Provider Name (Legal Business Name): PRIMARY CARE PLUS OF LEAWOOD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 W 135TH ST SUITE 190A
LEAWOOD KS
66224-8900
US

IV. Provider business mailing address

4900 W 135TH ST SUITE 190A
LEAWOOD KS
66224-8900
US

V. Phone/Fax

Practice location:
  • Phone: 913-428-8000
  • Fax: 913-428-8001
Mailing address:
  • Phone: 913-428-8000
  • Fax: 913-428-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ETHAN C RICHARD
Title or Position: PARTNER
Credential: DO
Phone: 913-428-8000