Healthcare Provider Details

I. General information

NPI: 1447664396
Provider Name (Legal Business Name): BENJAMIN SKOCH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CAMBRIDGE ST # MS 1020
KANSAS CITY KS
66160-1150
US

IV. Provider business mailing address

6675 HOLMES RD STE 360
KANSAS CITY MO
64131-1150
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-3807
  • Fax: 913-588-3877
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2014019003
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number0540072
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: