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General NPI Number Information
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NPI Number | 1194000570
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Entity Type | Organization
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Legal Business Name | PHOENIX HEALTHCARE CLINIC
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Dates
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Enumeration Date | 10/17/2011
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Last Update Date | 10/17/2011
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Provider Practice Location Address
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Address Line | 11960 QUIVIRA ROAD SUITE #100
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City | OVERLAND PARK
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State | KS
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Zip | 66213
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Country | US
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Telephone | 913-851-0500
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Fax | 913-851-0502
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Provider Business Mailing Address
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Address Line | 11960 QUIVIRA ROAD SUITE #100
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City | OVERLAND PARK
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State | KS
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Zip | 66213
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Country | US
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Telephone | 913-851-0500
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Fax | 913-851-0502
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Authorized Official
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Title or Position | APRN
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Name | DANA HANSON
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Credential | NP
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Telephone | 913-549-8197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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