Organization
ICARE PRIMARY CARE
Active
Other names
iCARE Addiction Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER PETERSEN (OFFICE MANAGER)
(816) 875-4325
Entity
Organization
Contact information
Practice address
550 RUSH CREEK PKWY, SUITE B, LIBERTY, MO 64068-9608
(816) 875-4325
(816) 407-9809
Mailing address
550 RUSH CREEK PKWY, SUITE B, LIBERTY, MO 64068-9608
(816) 875-4325
(816) 407-9809
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
20110330076
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1699716910
PHYSICIAN
—
Enumeration date
12/02/2014
Last updated
12/02/2014
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