MEDICARE: PROMOHISPANO 2 INC

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	332H00000X	Eyewear Supplier		MO

General Provider Information

NPI Number	:	1356621957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMOHISPANO 2 INC

Provider Business Mailing Address
First Line	:	4609 INDEPENDENCE AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64124-2927
Country	:	US
Telephone Number	:	816-231-2222
Fax Number	:	816-241-4214

Provider Business Practice Location Address
First Line	:	4609 INDEPENDENCE AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64124-2927
Country	:	US
Telephone Number	:	816-231-2222
Fax Number	:	816-241-4214

Authorized Official
Title or Position	:	SECRETARY
Name	:	ALYSSA QUINONES
Credential	:
Telephone Number	:	816-231-2222

Provider Enumeration Date	:	08/26/2011
Last Update Date	:	08/26/2011

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