Provider Demographics
NPI:1154417863
Name:CHUMLEY, HEIDI S (MD)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:S
Last Name:CHUMLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:S
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:4070 DELP MAIL STOP 4010
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-1908
Mailing Address - Fax:
Practice Address - Street 1:1059B DELP PAVILION
Practice Address - Street 2:MAIL STOP 4010
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-1908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-30811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO34448016OtherBCBS KANSAS CITY
KS200269780AMedicaid
MO208394304Medicaid
P00193406OtherRR MEDICARE
KS200269780AMedicaid
229D375AMedicare ID - Type Unspecified