Organization
TOWN PLAZA FAMILY PRACTICE, LLC
Active
Other names
Northridge Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
KEN WASHINGTON (VP)
(913) 254-0918
Entity
Organization
Contact information
Practice address
15270 W 119TH ST, OLATHE, KS 66062-5604
(913) 254-0828
Mailing address
15270 W 119TH ST, OLATHE, KS 66062-5604
(913) 254-0828
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11372027
BLUE COSS/BLUE SHIELD OF
MO
05
—
20-877559-01
—
KS
Enumeration date
06/14/2006
Last updated
08/22/2020
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