Healthcare Provider Details

I. General information

NPI: 1740184704
Provider Name (Legal Business Name): DICKSON DIVELEY MIDWEST ORTHOPAEDIC CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16825 W 86TH ST STE 120
LENEXA KS
66219-2405
US

IV. Provider business mailing address

3651 COLLEGE BLVD
LEAWOOD KS
66211-1910
US

V. Phone/Fax

Practice location:
  • Phone: 913-319-7600
  • Fax: 913-253-1704
Mailing address:
  • Phone: 913-319-7600
  • Fax: 913-253-1704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL

VIII. Authorized Official

Name: JACOB S STUEVE
Title or Position: AO
Credential:
Phone: 913-851-7780