Healthcare Provider Details

I. General information

NPI: 1720250590
Provider Name (Legal Business Name): CARONDELET PHYSICIAN SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14880 METCALF AVE
OVERLAND PARK KS
66223-2206
US

IV. Provider business mailing address

801 NW SAINT MARY DR SUITE 230
BLUE SPRINGS MO
64014-2524
US

V. Phone/Fax

Practice location:
  • Phone: 913-897-1151
  • Fax: 913-897-1150
Mailing address:
  • Phone: 816-655-5792
  • Fax: 816-655-5787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0431315
License Number StateKS

VIII. Authorized Official

Name: MR. STEVEN R CLEARY
Title or Position: CFO
Credential:
Phone: 816-943-2819