Organization
STATE LINE MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEN WASHINGTON (VP)
(816) 333-9886
Entity
Organization
Contact information
Practice address
7611 STATE LINE RD, SUITE 103, KANSAS CITY, MO 64114-6801
(816) 333-9886
Mailing address
7611 STATE LINE RD, SUITE 103, KANSAS CITY, MO 64114-6801
(816) 333-9886
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29398029
BCBS OF KC
MO
Enumeration date
05/26/2006
Last updated
08/22/2020
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