1316138316 NPI number — MYOCORE, LLC

Table of content: (NPI 1316138316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316138316 NPI number — MYOCORE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MYOCORE, 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:
6
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:
1316138316
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 SE MELODY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEES SUMMIT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64063-4804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-219-1977
Provider Business Mailing Address Fax Number:
816-434-0898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7900 LEE'S SUMMIT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64139-1246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-229-4430
Provider Business Practice Location Address Fax Number:
630-229-4430
Provider Enumeration Date:
08/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOSS
Authorized Official First Name:
JASON
Authorized Official Middle Name:
Authorized Official Title or Position:
DC
Authorized Official Telephone Number:
630-229-4430

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2007035558 , 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)