Healthcare Provider Details

I. General information

NPI: 1447027362
Provider Name (Legal Business Name): AGEWELL GERIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

793 NW 1621ST RD
BATES CITY MO
64011-8395
US

IV. Provider business mailing address

793 NW 1621ST RD
BATES CITY MO
64011-8395
US

V. Phone/Fax

Practice location:
  • Phone: 816-226-1182
  • Fax:
Mailing address:
  • Phone: 816-226-1182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES LAWRENZI
Title or Position: PHYSICIAN
Credential: DO
Phone: 573-381-0305