Provider Demographics
NPI:1154436442
Name:ORTHOKC PROFESSIONAL ASSOCIATION
Entity type:Organization
Organization Name:ORTHOKC PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-788-7111
Mailing Address - Street 1:8919 PARALLEL PKWY
Mailing Address - Street 2:SUITE 270
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-1636
Mailing Address - Country:US
Mailing Address - Phone:913-788-7111
Mailing Address - Fax:913-788-3702
Practice Address - Street 1:8919 PARALLEL PKWY
Practice Address - Street 2:SUITE 270
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1636
Practice Address - Country:US
Practice Address - Phone:913-788-7111
Practice Address - Fax:913-788-3702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Not Answered207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1880000AMedicare ID - Type Unspecified