Basic Information
| Provider Information | |||||||||
| NPI: | 1538297171 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HODGES | ||||||||
| FirstName: | JANIE | ||||||||
| MiddleName: | CAROL | ||||||||
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| Credential: | C.P.T.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6920 RENE CT | ||||||||
| Address2: | |||||||||
| City: | SHAWNEE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662162354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9139801375 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10300 W 103RD ST | ||||||||
| Address2: | SUITE 300 QUANTUM HEALTH PROFESSIONALS | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9138941910 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 14-00147 | KS | Y | Other Service Providers | Specialist | 174400000X | 117739 | MO | N | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 117739 | 01 | MO | C.P.T.A. | OTHER | 14-00147 | 01 | KS | C.P.T.A. | OTHER |