1811277999 NPI number — METROCARE OF GREATER KANSAS CITY

Table of content: GABRIELA VIRGINIA GUTIERREZ DE LEON (NPI 1578371266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811277999 NPI number — METROCARE OF GREATER KANSAS CITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROCARE OF GREATER KANSAS CITY
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:
1811277999
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 NICHOLS RD
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64112-1511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-531-8432
Provider Business Mailing Address Fax Number:
816-531-8438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 NICHOLS RD
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64112-1511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-531-8432
Provider Business Practice Location Address Fax Number:
816-531-8438
Provider Enumeration Date:
08/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WATSON
Authorized Official First Name:
JILL
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
816-531-8432

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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