Provider Demographics
NPI:1285917765
Name:STOCKRIDGE PHYSICIANS SERVICES LLC
Entity type:Organization
Organization Name:STOCKRIDGE PHYSICIANS SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:K
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:913-553-4614
Mailing Address - Street 1:PO BOX 521
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-0521
Mailing Address - Country:US
Mailing Address - Phone:316-927-3884
Mailing Address - Fax:316-927-3886
Practice Address - Street 1:5401 COLLEGE BLVD
Practice Address - Street 2:STE 203
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1923
Practice Address - Country:US
Practice Address - Phone:913-553-4614
Practice Address - Fax:913-553-4615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty