Healthcare Provider Details

I. General information

NPI: 1033178686
Provider Name (Legal Business Name): KANSAS CITY ALLERGY & ASTHMA ASSOCIATES P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8675 COLLEGE BLVD STE 200
OVERLAND PARK KS
66210-1835
US

IV. Provider business mailing address

8675 COLLEGE BLVD
OVERLAND PARK KS
66210-1863
US

V. Phone/Fax

Practice location:
  • Phone: 913-491-5501
  • Fax: 913-491-8901
Mailing address:
  • Phone: 913-491-5501
  • Fax: 913-491-8901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY CLARK
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 913-491-1830