MEDICARE: STREET MEDICINE KC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	251B00000X	Case Management Agency
3	251S00000X	Community/Behavioral Health Agency
4	261Q00000X	Clinic/Center
5	261QD0000X	Dental Clinic/Center
6	261QH0100X	Health Service Clinic/Center
7	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
8	261QM0850X	Adult Mental Health Clinic/Center
9	261QM0855X	Adolescent and Children Mental Health Clinic/Center
10	332900000X	Non-Pharmacy Dispensing Site
11	3336C0003X	Community/Retail Pharmacy
12	343900000X	Non-emergency Medical Transport (VAN)
13	261QC1500X	Community Health Clinic/Center

General Provider Information

NPI Number	:	1568066587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STREET MEDICINE KC

Provider Business Mailing Address
First Line	:	934 WYANDOTTE ST APT 406
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64105-1644
Country	:	US
Telephone Number	:	913-653-2897
Fax Number	:

Provider Business Practice Location Address
First Line	:	1444 E 8TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64106-1712
Country	:	US
Telephone Number	:	816-434-0581
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	EDGAR BENNETT JR.
Credential	:
Telephone Number	:	913-653-2897

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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Directions to “STREET MEDICINE KC ” Practice Location

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