1316137953 NPI number — MIDWEST HEMORRHOID TREATMENT CENTER NORTH KANSAS CITY LLC

Table of content: (NPI 1316137953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316137953 NPI number — MIDWEST HEMORRHOID TREATMENT CENTER NORTH KANSAS CITY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST HEMORRHOID TREATMENT CENTER NORTH KANSAS CITY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316137953
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7127
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHAWNEE MISSION
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66207-0127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-421-0601
Provider Business Mailing Address Fax Number:
816-421-0604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 CLAY EDWARDS DR
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
NORTH KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64116-3237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-421-0601
Provider Business Practice Location Address Fax Number:
816-421-0604
Provider Enumeration Date:
07/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOULTON
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
913-451-0600

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  LC0811343 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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