Provider Demographics
NPI:1194764142
Name:KATHY KINDER MD, LLC
Entity type:Organization
Organization Name:KATHY KINDER MD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KINDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-908-2554
Mailing Address - Street 1:PO BOX 12478
Mailing Address - Street 2:
Mailing Address - City:OVERLAND
Mailing Address - State:KS
Mailing Address - Zip Code:66282-2478
Mailing Address - Country:US
Mailing Address - Phone:913-908-2554
Mailing Address - Fax:913-438-5252
Practice Address - Street 1:9801 W 100TH TER
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-5306
Practice Address - Country:US
Practice Address - Phone:913-908-2554
Practice Address - Fax:913-438-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2008-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS22040313M00000X
MOR7J60313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208820118Medicaid
KS100190820CMedicaid
MO23270040OtherBCBS OF KANSAS CITY
MO23270040OtherBCBS OF KANSAS CITY
MO0009255AMedicare PIN
KSD05383Medicare UPIN
KS100190820CMedicaid