Provider Demographics
NPI:1992987861
Name:THOMAS W. FULBRIGHT M.D. P.A.
Entity type:Organization
Organization Name:THOMAS W. FULBRIGHT M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:APPLEBY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:913-261-2222
Mailing Address - Street 1:8901 W 74TH ST, SUITE 2
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2204
Mailing Address - Country:US
Mailing Address - Phone:913-261-2222
Mailing Address - Fax:913-261-2229
Practice Address - Street 1:8901 W 74TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2204
Practice Address - Country:US
Practice Address - Phone:913-261-2222
Practice Address - Fax:913-261-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0421442261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS39376012OtherBLUE CROSS BLUE SHIELD KC
MOMA1572Medicare UPIN
KSY220000Medicare PIN