Individual
BRETT R HAILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9100 W 74TH ST, SHAWNEE MISSION, KS 66204-4004
(913) 676-2214
Mailing address
PO BOX 2747, SHAWNEE MISSION, KS 66201-2747
(800) 968-6866
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
115613
MO
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
MD115613
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100403970A
—
KS
05
—
100403970B
—
KS
05
—
100403970C
—
KS
05
—
204743017
—
MO
01
—
27361039
BLUE CROSS BLUE SHIELD
—
01
—
27361059
BCBS OF KC MO GROUP # 30492021 ER PHYSICIANS SOUTH PA
KS
01
—
27361069
BCBS OF KC MO GROUP 01674018 SMMC EMERGENCY PHYSICIANS
KS
01
—
P00651782
RR MEDICARE GROUP CG8899
KS
01
—
P00721307
RR MEDICARE GROUP DC6712
KS
Enumeration date
07/21/2005
Last updated
06/30/2021
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