Healthcare Provider Details

I. General information

NPI: 1891010039
Provider Name (Legal Business Name): CPFCC MUR-LEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N MUR LEN RD STE 211
OLATHE KS
66062-1794
US

IV. Provider business mailing address

11755 W 112TH ST STE 202
OVERLAND PARK KS
66210-2742
US

V. Phone/Fax

Practice location:
  • Phone: 913-451-2253
  • Fax: 913-338-1311
Mailing address:
  • Phone: 913-469-0503
  • Fax: 913-338-1311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHUCK CHAMBERS
Title or Position: ADMINISTRATOR
Credential:
Phone: 913-469-0503