ADVANCED DERMATOLOGIC SURGERY, P.A. (NPI# 1003016312) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003016312 |
| Entity Type | Organization |
| Organization Name | ADVANCED DERMATOLOGIC SURGERY, P.A. |
| Other Organization Name | ADVANCED DERMATOLOGIC SURGERY |
| Practice Address |
6901 W 121st St Overland Park KS 66209-2007 |
| Practice Telephone | 9136611755 |
| Practice Fax Number | 9136619260 |
| Mailing Telephone | 9136611755 |
| Mailing Fax Number | 9136619260 |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2007-11-08 |
| Authorized Official Name | DR. TIMOTHY L PARKER (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 9136611755 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 291U00000X | Clinical Medical Laboratory | 04-25136 | KS | Laboratories |
| Y | 174400000X | Specialist | 04-25136 | KS | Other Service Providers |
| Other Name | Type Code |
|---|---|
| Advanced Dermatologic Surgery | Doing Business As Name - Organization |
| Street Address |
6901 W 121ST ST |
| City | OVERLAND PARK |
| State | KS |
| Zip Code | 66209-2007 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487659959 | Timothy L Parker | Dermatology | 6901 W 121st St, Overland Park, KS 66209-2007 | 2005-06-20 |
| 1689841025 | Thomas Lewis Hamaguchi Hocker | Dermatology | 6901 W 121st St, Overland Park, KS 66209-2007 | 2008-05-14 |
| 1649376757 | Ads Healthcare LLC | Clinic/Center | 6901 W 121st St, Overland Park, KS 66209-2007 | 2006-09-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265900286 | Kansas Wellness Associates LLC | Family Medicine | 4300 W 133rd Street, Suite 200, Leawood, KS 66209 | 2018-11-07 |
| 1740781871 | Courtney Collins | Physical Therapy Assistant | 6830 W. 121st. Ct, Overland Park, KS 66209 | 2018-02-23 |
| 1295246015 | Meredith Meyer Bell | Nurse Practitioner | 5064 W 130th Terrace, Leawood, KS 66209 | 2017-10-19 |
| 1740712223 | Margaret Alice Luckert | Registered Nurse | 5701 W 119th Street Suite 220, Overland Park, KS 66209 | 2017-04-03 |
| 1609311133 | Kansas City Community Hospital, LLC | General Acute Care Hospital | 13200 State Line Road, Leawood, KS 66209 | 2016-12-19 |
| 1316492499 | Christy Vopat | Occupational Therapist | 4952 W. 129 Th Terr, Leawood, KS 66209 | 2016-08-18 |
| 1861846594 | Paige Aberasturi Penick | Nutritionist | 6709 W 119th St # 207, Overland Park, KS 66209 | 2016-04-19 |
| 1568827905 | Eating Disorder Treatment Associates, LLC | Clinic/Center | 12140 Nall Avenue, Suite 315, Overland Park, KS 66209 | 2015-12-30 |
| 1689056483 | Michael Hauber | Physical Therapist | 12728 State Line Rd, Leawood, KS 66209 | 2015-06-29 |
| 1033597000 | Brooke J Heppner Mft | Marriage & Family Therapist | 6711 W. 121st Street, Suite 101, Overland Park, KS 66209 | 2015-05-11 |
| Find all providers in zip 66209 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164765707 | Solomon Batnitzky | Specialist | 9996 Mackey Cir, Overland Park, KS 66212-3458 | 2013-04-02 |
| 1821338005 | Susan Gliesman | Specialist | 15751 Beverly St, Overland Park, KS 66223-3567 | 2013-02-25 |
| 1982848479 | Jennifer Herynk Thomas | Specialist | 5820 W 85th Ter, Overland Park, KS 66207-1665 | 2009-04-28 |
| 1184876500 | Gary D Hall | Specialist | 14340 Metcalf Ave, Overland Park, KS 66223-2987 | 2008-10-16 |
| 1942459417 | Martha Byers | Specialist | 10600 Quivira Rd Ste 120, Overland Park, KS 66215-2311 | 2008-09-09 |
| 1871794024 | Sheryl Geistkemper-ragland | Specialist | 9700 W 96th St, Overland Park, KS 66212-5105 | 2007-05-29 |
| 1063628634 | L. Susan Herrman | Specialist | 10300 W 103rd St Ste 400, Overland Park, KS 66214-2642 | 2007-05-14 |
| 1609081173 | Shawn Marie Barry | Specialist | 10300 W. 103rd St. Suite 300, Overland Park, KS 66214 | 2007-05-10 |
| 1063531812 | Rebecca N Gaughan | Specialist | 12906 Goddard Ave, Overland Park, KS 66213-3487 | 2007-03-29 |
| 1568589398 | Jo Ellen Fuentes | Specialist | 15238 Broadmoor St, Overland Park, KS 66223-3137 | 2007-03-25 |
| Find all providers in OVERLAND PARK | ||||
| City | OVERLAND PARK |
| Zip Code | 66209 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.