Provider Demographics
NPI:1194967778
Name:OCCUPATIONAL & PREVENTIVE MEDICINE SERVICES
Entity type:Organization
Organization Name:OCCUPATIONAL & PREVENTIVE MEDICINE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CONG
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-787-1423
Mailing Address - Street 1:16815 W 84TH ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-8057
Mailing Address - Country:US
Mailing Address - Phone:913-787-1423
Mailing Address - Fax:913-322-1427
Practice Address - Street 1:920 6TH AVE
Practice Address - Street 2:MEDICAL ARTS BUILDING
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-3225
Practice Address - Country:US
Practice Address - Phone:913-682-7225
Practice Address - Fax:913-651-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-29
Last Update Date:2009-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0431475261QP2300X, 261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care