Organization
JACKSON DRIVE EMERGENCY PHYSICIANS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY KONDAS (OFFICER)
(973) 251-1132
Entity
Organization
Contact information
Practice address
19600 E 39TH ST S, INDEPENDENCE, MO 64057-2301
(816) 698-7000
Mailing address
13737 NOEL RD, STE 1600, DALLAS, TX 75240-1331
(214) 712-2444
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
12/15/2013
Last updated
12/21/2020
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