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Organization
COLLEGE PARK FAMILY CARE CENTER, P.A.
Active
Organization
COLLEGE PARK FAMILY CARE CENTER, P.A.
Active
Other names
Ambulatory Surgical Center
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES O. CHAMBERS (ADMINISTRATOR)
(913) 469-0503
Entity
Organization
Contact information
Practice address
11725 W 112TH ST, OVERLAND PARK, KS 66210-2761
(913) 469-5579
(913) 338-1311
Mailing address
11725 W 112TH ST, OVERLAND PARK, KS 66210-2761
(913) 469-5579
(913) 338-1311
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
S-046-007
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8500019
MEDICARE
KS
Enumeration date
07/25/2006
Last updated
12/10/2007
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