Provider Demographics
NPI:1548353899
Name:INTENSIVE DIABETES MANAGEMENT
Entity type:Organization
Organization Name:INTENSIVE DIABETES MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:PAQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-596-4000
Mailing Address - Street 1:PO BOX 12352
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-0352
Mailing Address - Country:US
Mailing Address - Phone:913-596-3940
Mailing Address - Fax:913-596-3950
Practice Address - Street 1:8919 PARALLEL PKWY
Practice Address - Street 2:SUITE 360
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1636
Practice Address - Country:US
Practice Address - Phone:913-596-3940
Practice Address - Fax:913-596-3950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
34213011OtherBCBS KANSAS CITY
R290000Medicare ID - Type UnspecifiedKANSAS CITY
KS111128Medicare ID - Type UnspecifiedBCBS KANSAS
34213011OtherBCBS KANSAS CITY