Healthcare Provider Details

I. General information

NPI: 1922520725
Provider Name (Legal Business Name): LANDMARK ANESTHESIA OF KANSAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 09/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 W 110TH ST # 300
OVERLAND PARK KS
66211-1501
US

IV. Provider business mailing address

1653 S BELLEMEADE DR
BLOOMINGTON IN
47401-8671
US

V. Phone/Fax

Practice location:
  • Phone: 913-469-6777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHAD JOHNSON
Title or Position: PARTNER
Credential: MD
Phone: 812-345-2922