Provider Demographics
NPI:1992997043
Name:MYO INC
Entity type:Organization
Organization Name:MYO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-710-8440
Mailing Address - Street 1:6013 LEAVENWORTH RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66104-1436
Mailing Address - Country:US
Mailing Address - Phone:913-281-2090
Mailing Address - Fax:913-788-9400
Practice Address - Street 1:6013 LEAVENWORTH RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66104-1436
Practice Address - Country:US
Practice Address - Phone:913-281-2090
Practice Address - Fax:913-788-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS167762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSUPIN D90217Medicare UPIN
Q718532Medicare PIN
Q710000Medicare PIN