Provider Demographics
NPI:1902224504
Name:LORI ANN GOLON MD PA
Entity type:Organization
Organization Name:LORI ANN GOLON MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHEIF REVENUE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KLINGENSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-379-2266
Mailing Address - Street 1:19800 METCALF AVE # MB36
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:KS
Mailing Address - Zip Code:66085-2600
Mailing Address - Country:US
Mailing Address - Phone:913-379-2266
Mailing Address - Fax:713-344-9420
Practice Address - Street 1:10500 QUIVIRA RD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2373
Practice Address - Country:US
Practice Address - Phone:133-792-2669
Practice Address - Fax:713-344-9420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-01
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1114019593Medicaid
KS1629160007Medicaid