Provider Demographics
NPI:1063504272
Name:CIRCLE OF LIFE
Entity type:Organization
Organization Name:CIRCLE OF LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:PEGHEE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD,
Authorized Official - Phone:913-684-1100
Mailing Address - Street 1:1001 6TH AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-3222
Mailing Address - Country:US
Mailing Address - Phone:913-684-1100
Mailing Address - Fax:
Practice Address - Street 1:1001 6TH AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-3222
Practice Address - Country:US
Practice Address - Phone:913-684-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS=========OtherTAX ID