Organization
SPINE & SCOLIOSIS SURGERY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER P. JACKSON M.D. (PRESIDENT)
(816) 471-6611
Entity
Organization
Contact information
Practice address
2790 CLAY EDWARDS DR STE 630, NORTH KANSAS CITY, MO 64116
(816) 471-6611
(816) 471-6192
Mailing address
2790 CLAY EDWARDS DR STE 630, NORTH KANSAS CITY, MO 64116-3274
(816) 471-6611
(816) 471-6192
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
R5717
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012289011
BCBS OF KC
—
01
—
09-00221
UNITED HEALTHCARE
—
01
—
200018411
RAILROAD MEDICARE
—
01
—
4571391
AETNA
—
Enumeration date
01/04/2007
Last updated
06/05/2018
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