Tierra Lakes Medical Group, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

TIERRA LAKES MEDICAL GROUP, LLC

Practice address

4969 N Tierra Lakes Pkwy
Bel Aire, KS 67226-3345

Phone

(316) 440-4820

Fax

(316) 440-4851

NPI assigned

Sep 28, 2016

Organization subpart

No

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

Authorized official

Name

Jannifer Terry, RN

Title

Owner

Phone

(316) 440-4820

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1475020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475020800000",
    "number": "1639628829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4969 N TIERRA LAKES PKWY",
            "city": "BEL AIRE",
            "state": "KS",
            "postal_code": "672263345",
            "telephone_number": "316-440-4820",
            "fax_number": "316-440-4851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4969 N TIERRA LAKES PKWY",
            "city": "BEL AIRE",
            "state": "KS",
            "postal_code": "672263345",
            "telephone_number": "316-440-4820",
            "fax_number": "316-440-4851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIERRA LAKES MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-28",
        "last_updated": "2016-09-28",
        "status": "A",
        "authorized_official_last_name": "TERRY",
        "authorized_official_first_name": "JANNIFER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "316-440-4820",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Bel Aire, KS
• Providers in Bel Aire, KS by specialty
• Specialist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2016; 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.