MEDICARE: DR. MARY ELLEN MCGINNIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	R3E27	MO

General Provider Information

NPI Number	:	1225142078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY ELLEN MCGINNIS MD

Provider Business Mailing Address
First Line	:	809 W 125TH TER
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64145-1169
Country	:	US
Telephone Number	:	816-943-8436
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 EAST LINWOOD BOULEVARD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64128-2295
Country	:	US
Telephone Number	:	816-861-4700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/08/2007

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