Organization
STOPGAP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK L ANDERSON MBA (FINANCIAL OFFICER)
(844) 362-8255
Entity
Organization
Contact information
Practice address
202 ADMIRAL BLVD, KANSAS CITY, MO 64106-1504
(844) 362-8255
Mailing address
202 ADMIRAL BLVD, KANSAS CITY, MO 64106-1504
(844) 362-8255
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500054437
—
MO
Enumeration date
05/24/2018
Last updated
10/23/2018
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