# EXCELSIOR SPRINGS PHYSICIANS CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629491105
- **Authorized official:** MRS. JENNIFER L BOOMGARDEN CRMA, BSHSA, EMBA (PHYSICIANS PRACTICE MANAGER)
- **Authorized official phone:** (816) 629-2623

## Contact information

- **Practice address:** 1700 RAINBOW BLVD, EXCELSIOR SPRINGS, MO 64024-1182
- **Practice address phone:** (816) 629-2623
- **Practice address fax:** (816) 629-2722
- **Mailing address:** 1010 N JESSE JAMES RD, EXCELSIOR SPRINGS, MO 64024-1202
- **Mailing address phone:** (816) 630-6722
- **Mailing address fax:** (816) 630-2471

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0000X | Adolescent Medicine (Family Medicine) Physician | R6J43 | MO | Yes |

## Other

- **Enumeration date:** 02/04/2014
- **Last updated:** 02/04/2014