Healthcare Provider Details

I. General information

NPI: 1538671946
Provider Name (Legal Business Name): THE BARIATRIC CENTER OF KANSAS CITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23401 PRAIRIE STAR PKWY # 350
LENEXA KS
66227
US

IV. Provider business mailing address

23401 PRAIRIE STAR PARKWAY B300
LENEXA KS
66227
US

V. Phone/Fax

Practice location:
  • Phone: 913-676-8690
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State

VIII. Authorized Official

Name: KARSTEN RANDOLPH
Title or Position: CFO
Credential:
Phone: 913-676-2152