Basic Information
| Provider Information | |||||||||
| NPI: | 1528250941 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLLEGE PARK FAMILY CARE CENTER, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11755 W 112TH ST | ||||||||
| Address2: | STE 203 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662102761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134690503 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10590 BARKLEY ST | ||||||||
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| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662121811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134988120 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2007 | ||||||||
| LastUpdateDate: | 08/10/2007 | ||||||||
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| AuthorizedOfficialLastName: | CHAMBERS | ||||||||
| AuthorizedOfficialFirstName: | CHUCK | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9134690503 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
No ID Information.