=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366615908
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARTIN P. O'LAUGHLIN MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2008
-----------------------------------------------------
Last Update Date | 04/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4400 BROADWAY ST SUITE 400
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64111-3498
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-931-5440
-----------------------------------------------------
Fax | 816-931-6667
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4400 BROADWAY ST SUITE 400
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64111-3498
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-931-5440
-----------------------------------------------------
Fax | 816-931-6667
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARTIN P O'LAUGHLIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 913-381-5200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0202X
-----------------------------------------------------
Taxonomy Name | Pediatric Cardiology Physician
-----------------------------------------------------
License Number | 2002007287
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------