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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