Organization
EXCELSIOR SPRINGS PHYSICIANS CLINICS LLC
Active
Organization
EXCELSIOR SPRINGS PHYSICIANS CLINICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER L BOOMGARDEN CRMA, BSHSA, EMBA (PHYSICIANS PRACTICE MANAGER)
(816) 629-2623
Entity
Organization
Contact information
Practice address
1700 RAINBOW BLVD, EXCELSIOR SPRINGS, MO 64024-1182
(816) 629-2623
(816) 629-2722
Mailing address
613 W 6TH ST, LAWSON, MO 64062-8973
(816) 580-0055
(816) 580-0064
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D0113134
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA4388
MEDICARE ID
MO
Enumeration date
02/04/2014
Last updated
02/04/2014
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