Organization
PROVIDENCE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIEDRE MCDANIEL NA (MEDICAL STAFF OFFICE)
(913) 596-4000
Entity
Organization
Contact information
Practice address
8919 PARALLEL PKWY STE 555, KANSAS CITY, KS 66112-3628
(913) 596-3930
Mailing address
8919 PARALLEL PKWY STE 555, KANSAS CITY, KS 66112-3628
(913) 596-3930
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1598741472
NPI
KS
Enumeration date
11/25/2019
Last updated
11/26/2019
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