Basic Information
| Provider Information | |||||||||
| NPI: | 1417004300 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENDERSON | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8717 W 110TH ST | ||||||||
| Address2: | BLDG 14, STE 600 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662102144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134282900 | ||||||||
| FaxNumber: | 9134282951 | ||||||||
| Practice Location | |||||||||
| Address1: | OVERLAND PARK REG. MED CENTER, DEPT. OF ANESTHESIOLOGY | ||||||||
| Address2: | 10500 QUIVIRA ROAD | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3134282900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 08/07/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 2007013970 | MO | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 04-32460 | KS | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | MD0000040132 | TN | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 26906 | NE | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 200443340A | 05 | KS | MEDICAID | 204466601 | 05 | MO | MEDICAID |