MEDICARE: MRS. MARY J SHORT MD

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	207R00000X	Internal Medicine Physician	04-18170	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R1C52	OTHER	MO	MEDICAL LICENSE
2	04-18170	OTHER	KS	MEDICAL LICENSE

General Provider Information

NPI Number	:	1821083320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY J SHORT MD

Provider Business Mailing Address
First Line	:	10550 QUIVIRA RD
Second Line	:	SUITE 200
City	:	OVERLAND PARK
State	:	KS
Zip	:	66215-2306
Country	:	US
Telephone Number	:	913-541-3340
Fax Number	:	913-492-7857

Provider Business Practice Location Address
First Line	:	10550 QUIVIRA RD
Second Line	:	SUITE 200
City	:	OVERLAND PARK
State	:	KS
Zip	:	66215-2306
Country	:	US
Telephone Number	:	913-541-3340
Fax Number	:	913-492-7857

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	08/28/2007

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