Provider Demographics
NPI:1780879858
Name:JOHN A. GILLEN II MD ORTHOPAEDIC SPECIALISTS P.A.
Entity type:Organization
Organization Name:JOHN A. GILLEN II MD ORTHOPAEDIC SPECIALISTS P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GILLEN
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:816-331-6700
Mailing Address - Street 1:PO BOX 412043
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-2043
Mailing Address - Country:US
Mailing Address - Phone:913-647-4102
Mailing Address - Fax:913-647-4122
Practice Address - Street 1:900 MAIN ST
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-2477
Practice Address - Country:US
Practice Address - Phone:816-331-6700
Practice Address - Fax:816-876-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO17519026OtherBCBSKC GROUP #
MODC5878OtherRR MEDICARE GROUP #
MOR500000AMedicare PIN
MOR500000Medicare PIN
KSR500000BMedicare PIN
MO5515220001Medicare NSC