Organization
ST JOSEPH SPECIALTY CLINIC PC
Active
Other names
St Joseph Specialty Clinic PC
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH W SHEWELL MD (SECRETARY)
(816) 866-5105
Entity
Organization
Contact information
Practice address
2600 MILLER ST, BETHANY, MO 64424-2701
(660) 425-0253
Mailing address
PO BOX 8657, SAINT JOSEPH, MO 64508-8657
(816) 866-5105
(816) 207-0454
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
112862
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208865105
—
MO
Enumeration date
07/23/2006
Last updated
01/04/2023
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