MEDICARE: ADVANCED HEALTHCARE & SPORTS INJURY, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	KS0421704	KS

General Provider Information

NPI Number	:	1811345432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED HEALTHCARE & SPORTS INJURY, PA

Provider Business Mailing Address
First Line	:	20160 W. 153RD STREET
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-9131
Country	:	US
Telephone Number	:	913-764-2271
Fax Number	:	913-764-2276

Provider Business Practice Location Address
First Line	:	20160 W. 153RD STREET
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-9131
Country	:	US
Telephone Number	:	913-764-2271
Fax Number	:	913-764-2276

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KIRK J IODICE
Credential	:	D.C.
Telephone Number	:	913-764-2271

Provider Enumeration Date	:	05/25/2016
Last Update Date	:	05/25/2016

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