Healthcare Provider Details

I. General information

NPI: 1790547172
Provider Name (Legal Business Name): ANSIBLE HEALTH MEDICAL GROUP OF KANSAS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 WEST 110TH STREET COMMERCE PLAZA I, 7TH FLOOR
OVERLAND PARK KS
66210
US

IV. Provider business mailing address

1032 E BRANDON BLVD # 4253
BRANDON FL
33511-5509
US

V. Phone/Fax

Practice location:
  • Phone: 877-267-4253
  • Fax:
Mailing address:
  • Phone: 877-267-4253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: RICIELLE TIMTIMAN
Title or Position: CREDENTIALING LEAD
Credential:
Phone: 276-208-7087