Healthcare Provider Details

I. General information

NPI: 1356533913
Provider Name (Legal Business Name): MILBURN MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9303 W 75TH ST SUITE 110
OVERLAND PARK KS
66204-2234
US

IV. Provider business mailing address

9303 W 75TH ST SUITE 110
OVERLAND PARK KS
66204-2234
US

V. Phone/Fax

Practice location:
  • Phone: 913-341-8222
  • Fax: 913-341-8272
Mailing address:
  • Phone: 913-341-8222
  • Fax: 913-341-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number004-F-01
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number004-F-01
License Number StateKS

VIII. Authorized Official

Name: LISA L MILBURN
Title or Position: PRESIDENT
Credential: CPED COF
Phone: 913-341-8222