Organization
CARONDELET PHYSICIAN SERVICES INC
Active
Parent organization
CARONDELET HEALTH
Other names
Oak Grove Medical Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
CARONDELET HEALTH
Authorized official
MR. STEVEN R CLEARY (VP/CFO)
(816) 943-2819
Entity
Organization
Contact information
Practice address
1900 S BROADWAY, OAK GROVE, MO 64075-9020
(816) 690-6566
(816) 625-8276
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
34421
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39532013
BCBS OF KANSAS CITY
—
05
—
501269500
—
MO
Enumeration date
01/28/2011
Last updated
05/04/2011
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