College Park Ancillary, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

COLLEGE PARK ANCILLARY, LLC

Practice address

10600 Mastin St
Overland Park, KS 66212-5723

Phone

(913) 438-0868

NPI assigned

Jun 3, 2013

Last updated

Jun 4, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Todd Carlon

Title

Vice President

Phone

(816) 508-4090

Specialties & licenses 1

Addresses

Tax ID family

College Park Ancillary LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• College Park Ancillary, LLC

  dba College Park Physical Therapy

  • Physical Therapy Clinic/Center
  • Overland Park, KS
  • NPI 1356617757
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1370217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370304000000",
    "number": "1508203241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11755 W 112TH ST",
            "address_2": "SUITE 202",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662102742",
            "telephone_number": "913-469-0433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10600 MASTIN ST",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662125723",
            "telephone_number": "913-438-0868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLEGE PARK ANCILLARY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-03",
        "last_updated": "2013-06-04",
        "status": "A",
        "authorized_official_last_name": "CARLON",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "816-508-4090"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheena Jo Coleman, NP
• Whitney T Coleman, O.D.
• Colin N Mackenzie MD LC
• Michael Allan-Joseph Colin, LPC, LMAC, CTP, NCC
• College Park Ancillary, LLC (College Park Physical Therapy)
• College Park Endoscopy Center LLC (College Park Surgery Center)
• College Park Family Care Center PA
• College Park Family Care Center, P.a.
• College Park Family Care Center, P.a.
• College Park Family Care Center, P.a.

• Ambulatory Surgical Clinic/Center in Overland Park, KS
• Providers in Overland Park, KS by specialty
• Ambulatory Surgical Clinic/Center in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.