Provider Demographics
NPI:1366121527
Name:PATHEOUS MEDICAL PLLC
Entity type:Organization
Organization Name:PATHEOUS MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CORREY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-233-6307
Mailing Address - Street 1:6601 COLLEGE BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1504
Mailing Address - Country:US
Mailing Address - Phone:913-233-6307
Mailing Address - Fax:
Practice Address - Street 1:6601 COLLEGE BLVD STE 120
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1504
Practice Address - Country:US
Practice Address - Phone:913-233-6307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-14
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty