MEDICARE: MEDICALODGES, 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	314000000X	Skilled Nursing Facility	N105005	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558461822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICALODGES, INC.

Provider Business Mailing Address
First Line	:	6261 LEAVENWORTH RD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66104-1445
Country	:	US
Telephone Number	:	913-299-9722
Fax Number	:	913-299-4652

Provider Business Practice Location Address
First Line	:	6261 LEAVENWORTH RD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66104-1445
Country	:	US
Telephone Number	:	913-299-9722
Fax Number	:	913-299-4652

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. SCOTT L HINES
Credential	:
Telephone Number	:	620-709-0305

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	11/01/2011

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Directions to “MEDICALODGES, INC. ” Practice Location

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