Provider Demographics
NPI:1538533443
Name:COTTONWOOD SPRINGS PHYSICIAN GROUP LLC
Entity type:Organization
Organization Name:COTTONWOOD SPRINGS PHYSICIAN GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-353-3000
Mailing Address - Street 1:100 HAZEL LN STE 305
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1249
Mailing Address - Country:US
Mailing Address - Phone:412-588-3546
Mailing Address - Fax:412-710-7068
Practice Address - Street 1:13351 S ARAPAHO DR
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1520
Practice Address - Country:US
Practice Address - Phone:913-353-3000
Practice Address - Fax:913-353-3001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPRINGSTONE HOLDINGS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-17
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201146370AMedicaid