Provider Demographics
NPI:1851463624
Name:OLATHE CANCER CARE, P.A.
Entity type:Organization
Organization Name:OLATHE CANCER CARE, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELODIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-780-4000
Mailing Address - Street 1:20375 W 151ST ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7218
Mailing Address - Country:US
Mailing Address - Phone:913-780-4000
Mailing Address - Fax:913-780-4038
Practice Address - Street 1:20375 W 151ST ST
Practice Address - Street 2:SUITE 208
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7218
Practice Address - Country:US
Practice Address - Phone:913-780-4000
Practice Address - Fax:913-780-4038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0430533174400000X
KS0420572174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100208120AMedicaid
KS200266340AMedicaid
KS200266330AMedicaid
KS34068015OtherBC OF KANSAS CITY
KS622146OtherBC OF KANSAS
KS13873018OtherBC OF KANSAS CITY
KSE06688Medicare UPIN
KSQ937165Medicare ID - Type UnspecifiedDAVID L. LEE, MD
KS200266340AMedicaid
KSQ930052Medicare ID - Type UnspecifiedLARRY R CORUM, MD
KS100208120AMedicaid