MEDICARE: INDEPENDENT ORTHOPAEDICS AND SPORTS MEDICINE OF KANSAS P A

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	207X00000X	Orthopaedic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	N60000	OTHER		PTAN

General Provider Information

NPI Number	:	1295704518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT ORTHOPAEDICS AND SPORTS MEDICINE OF KANSAS P A

Provider Business Mailing Address
First Line	:	5140 NE ANTIOCH RD
Second Line	:	SUITE A
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-2523
Country	:	US
Telephone Number	:	816-221-2663
Fax Number	:

Provider Business Practice Location Address
First Line	:	5140 NE ANTIOCH RD
Second Line	:	SUITE B
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-2523
Country	:	US
Telephone Number	:	816-221-2663
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RONALD ZIPPER
Credential	:	D.O.
Telephone Number	:	816-221-2663

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	12/18/2015

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