Healthcare Provider Details

I. General information

NPI: 1992087266
Provider Name (Legal Business Name): SIGNATURE MEDICAL GROUP OF KC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 NALL AVE SUITE 200
OVERLAND PARK KS
66211-1363
US

IV. Provider business mailing address

10701 NALL AVE STE 200
OVERLAND PARK KS
66211-1358
US

V. Phone/Fax

Practice location:
  • Phone: 913-381-5225
  • Fax: 913-901-0186
Mailing address:
  • Phone: 913-381-5225
  • Fax: 913-901-0186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CHAD SACKMAN
Title or Position: CEO
Credential:
Phone: 314-849-0311