Provider Demographics
NPI:1124424981
Name:SUPPLEMENTAL HEALTH CARE
Entity type:Organization
Organization Name:SUPPLEMENTAL HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESPIRATORY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TREZVANT
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:913-461-5934
Mailing Address - Street 1:6700 ANTIOCH RD STE 120
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204-1200
Mailing Address - Country:US
Mailing Address - Phone:913-652-9229
Mailing Address - Fax:
Practice Address - Street 1:6700 ANTIOCH RD STE 120
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-1200
Practice Address - Country:US
Practice Address - Phone:913-652-9229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital