Organization
NORTHLAND GASTROENTEROLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BRANDI E POTTER (BILLING)
(816) 554-3838
Entity
Organization
Contact information
Practice address
1345 N JESSE JAMES RD, EXCELSIOR SPRINGS, MO 64024-1183
(816) 630-0900
(816) 637-3250
Mailing address
1345 N JESSE JAMES RD, EXCELSIOR SPRINGS, MO 64024-1183
(816) 630-0900
(816) 637-3250
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
R9779
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09040299
BCBS
MO
Enumeration date
11/07/2006
Last updated
07/08/2008
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