Healthcare Provider Details

I. General information

NPI: 1093500944
Provider Name (Legal Business Name): GETASEW BAYE LEGASIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 S CLEARWATER HILLS ST
OLATHE KS
66061-5263
US

IV. Provider business mailing address

921 S CLEARWATER HILLS ST
OLATHE KS
66061-5263
US

V. Phone/Fax

Practice location:
  • Phone: 913-850-3879
  • Fax:
Mailing address:
  • Phone: 913-850-3879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number952SCG
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: