Healthcare Provider Details

I. General information

NPI: 1831860956
Provider Name (Legal Business Name): KANSAS OCCUPATIONAL MEDICINE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16801 W 116TH ST
LENEXA KS
66219-9603
US

IV. Provider business mailing address

PO BOX 1065
LOWELL AR
72745-1065
US

V. Phone/Fax

Practice location:
  • Phone: 913-538-0777
  • Fax:
Mailing address:
  • Phone: 479-725-3046
  • Fax: 479-725-3098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TERRY GUY
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 479-725-3043