Organization
SAMUEL U. RODGERS HEALTH CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT THEIS CPA, BA, MA (ACTING CHIEF EXECUTIVE OFFICER)
(816) 474-4920
Entity
Organization
Contact information
Practice address
825 EUCLID AVENUE, KANSAS CITY, MO 64124
(816) 474-4920
(816) 889-1845
Mailing address
825 EUCLID AVENUE, KANSAS CITY, MO 64124-2323
(816) 474-4920
(816) 889-1845
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
H80CS00784
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500859111
—
MO
Enumeration date
08/01/2006
Last updated
06/11/2019
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