Organization
PREMIER SPINE CARE, P.A.
Active
Other names
Premier Spine Care Overland Park
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN M CICCARELLI MD (PHYSICIAN)
(913) 322-2700
Entity
Organization
Contact information
Practice address
7840 W 165TH ST STE 280, OVERLAND PARK, KS 66223-3022
(913) 322-2700
(913) 322-7890
Mailing address
PO BOX 26250, OVERLAND PARK, KS 66225-6250
(913) 322-2700
(913) 322-7890
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0430147
STATE LICENSE
KS
01
—
0431121
STATE LICENSE
KS
Enumeration date
03/18/2022
Last updated
03/18/2022
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