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Organization
KCMOSD
Active
Organization
KCMOSD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KCMO SD (CLINIC)
(816) 418-8653
Entity
Organization
Contact information
Practice address
3221 INDIANA AVE, KANSAS CITY, MO 64128-2062
(816) 418-2075
Mailing address
1215 E TRUMAN RD, KANSAS CITY, MO 64106-3152
(816) 418-8653
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
NULL
Other
Enumeration date
03/21/2007
Last updated
08/22/2020
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