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General NPI Number Information
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NPI Number | 1437314838
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Entity Type | Organization
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Legal Business Name | OVERLAND PARK SURGICAL SPECIALTIES, LLC
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Dates
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Enumeration Date | 07/24/2008
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 15101 GLENWOOD AVE
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City | STANLEY
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State | KS
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Zip | 66223-3154
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Country | US
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Telephone | 913-681-8866
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 741331
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City | ATLANTA
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State | GA
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Zip | 30374-1331
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Country | US
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Telephone | 913-469-0503
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CHUCK CHAMBERS
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Credential |
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Telephone | 913-469-0503
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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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