Healthcare Provider Details

I. General information

NPI: 1730547167
Provider Name (Legal Business Name): COMPREHENSIVE CONCUSSION CARE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2016
Last Update Date: 01/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11940 W 119TH ST
OVERLAND PARK KS
66213-2216
US

IV. Provider business mailing address

27850 SILVER WRAITH DR
OLATHE KS
66061-8912
US

V. Phone/Fax

Practice location:
  • Phone: 913-907-9554
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number04-28802
License Number StateKS

VIII. Authorized Official

Name: PREM PARMAR
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 913-351-3005