Organization
CARONDELET PHYSICIAN SERVICES, INC.
Active
Parent organization
CARONDELET HEALTH
Other names
Grain Valley Family Physicians
Organization subpart
Yes
Provider details
NPI number
Legal business name
CARONDELET HEALTH
Authorized official
MR. STEVEN R CLEARY (VP AND CFO)
(816) 943-2819
Entity
Organization
Contact information
Practice address
1454 SW EAGLES PKWY, GRAIN VALLEY, MO 64029-8508
(816) 847-2390
(816) 847-2392
Mailing address
801 NW SAINT MARY DR, SUITE 230, BLUE SPRINGS, MO 64014-2524
(816) 655-5792
(816) 655-5787
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
106682
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39532013
BLUE CROSS BLUE SHIELD OF KANSAS CITY
—
05
—
501269500
—
MO
Enumeration date
03/19/2012
Last updated
03/19/2012
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