Provider Demographics
NPI:1548456551
Name:HORMONE HAIR VEIN CENTER
Entity type:Organization
Organization Name:HORMONE HAIR VEIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-631-0277
Mailing Address - Street 1:12616 W 62ND TER
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66216-1814
Mailing Address - Country:US
Mailing Address - Phone:913-631-0277
Mailing Address - Fax:
Practice Address - Street 1:12616 W 62ND TER
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66216-1814
Practice Address - Country:US
Practice Address - Phone:913-631-0277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1790707529Medicare NSC