MEDICARE: FOUR B CORP

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	261QC1800X	Corporate Health Clinic/Center

General Provider Information

NPI Number	:	1417100900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUR B CORP

Provider Business Mailing Address
First Line	:	5300 SPEAKER RD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66106-1050
Country	:	US
Telephone Number	:	913-573-1254
Fax Number	:

Provider Business Practice Location Address
First Line	:	9550 BLUE RIDGE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64134-1338
Country	:	US
Telephone Number	:	816-761-6660
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY & WHOLE HEALTH
Name	:	MICHAEL HALLIWELL
Credential	:	RPH
Telephone Number	:	913-573-1254

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	10/28/2008

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Directions to “FOUR B CORP ” Practice Location

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