Organization
COLLEGE PARK FAMILY CARE CENTER, P.A.
Active
Other names
College Park Radiology
Organization subpart
No
Provider details
NPI number
Authorized official
CHUCK CHAMBERS (ADMINISTRATOR)
(913) 469-0503
Entity
Organization
Contact information
Practice address
11755 W 112TH ST, STE. 101, OVERLAND PARK, KS 66210-2761
(913) 469-0503
(913) 338-1311
Mailing address
11755 W 112TH ST, STE. 101, OVERLAND PARK, KS 66210-2761
(913) 469-0503
(913) 338-1311
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0484665
AETNA
KS
01
—
5696741
AETNA
KS
Enumeration date
05/22/2007
Last updated
08/10/2007
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