Provider Demographics
NPI:1700545688
Name:DMMKP CORPORATION
Entity type:Organization
Organization Name:DMMKP CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-957-9486
Mailing Address - Street 1:9240 GLENWOOD ST STE B
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-1370
Mailing Address - Country:US
Mailing Address - Phone:913-685-9700
Mailing Address - Fax:913-543-3920
Practice Address - Street 1:9240 GLENWOOD ST STE B
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1370
Practice Address - Country:US
Practice Address - Phone:913-685-9700
Practice Address - Fax:913-543-3920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care