MEDICARE: JOSEPH YASSO

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	207Q00000X	Family Medicine Physician	DO R8168	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080117339	OTHER	MO	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1912946047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH YASSO

Provider Business Mailing Address
First Line	:	3600 NE RALPH POWELL RD
Second Line	:	SUITE C
City	:	LEES SUMMIT
State	:	MO
Zip	:	64064-2369
Country	:	US
Telephone Number	:	816-875-1105
Fax Number	:	816-875-1103

Provider Business Practice Location Address
First Line	:	3600 NE RALPH POWELL RD
Second Line	:	SUITE C
City	:	LEES SUMMIT
State	:	MO
Zip	:	64064-2369
Country	:	US
Telephone Number	:	816-875-1105
Fax Number	:	816-875-1103

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	10/31/2007

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Directions to “ JOSEPH YASSO ” Practice Location

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