Organization
SIGNATURE MEDICAL GROUP OF KC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MIKE STEPHENSON (ADMINISTATOR)
(913) 381-5225
Entity
Organization
Contact information
Practice address
12639 OLD TESSON RD, SUITE 115, SAINT LOUIS, MO 63128-2786
(314) 849-0311
(314) 849-4423
Mailing address
10701 NALL AVE, SUITE 200, OVERLAND PARK, KS 66211-1363
(913) 381-5225
(913) 901-0186
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6684440001
MEDICARE PTAN
KS
Enumeration date
11/29/2011
Last updated
08/27/2024
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