Healthcare Provider Details

I. General information

NPI: 1235220591
Provider Name (Legal Business Name): BRIAN S NORTHCUTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1337 S FOUNTAIN DR
OLATHE KS
66061-7205
US

IV. Provider business mailing address

PO BOX 6234
LINCOLN NE
68506-0234
US

V. Phone/Fax

Practice location:
  • Phone: 913-397-7801
  • Fax: 913-397-7801
Mailing address:
  • Phone: 402-613-2945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberQ6250
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTEP5516
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: