=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467866954
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHAWNEE MISSION PSYCHIATRIC SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2014
-----------------------------------------------------
Last Update Date | 06/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8340 MISSION RD STE 210
-----------------------------------------------------
City | PRAIRIE VILLAGE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66206-1362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-642-0100
-----------------------------------------------------
Fax | 913-642-0176
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8340 MISSION RD STE 210
-----------------------------------------------------
City | PRAIRIE VILLAGE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66206-1362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-642-0100
-----------------------------------------------------
Fax | 913-642-0176
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | UMAR WADOOD
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 913-642-0100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 0423898
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------