Healthcare Provider Details

I. General information

NPI: 1225335250
Provider Name (Legal Business Name): LEE'S SUMMIT PHYSICIANS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 NW SOUTH OUTER RD
BLUE SPRINGS MO
64015-2963
US

IV. Provider business mailing address

1600 NW SOUTH OUTER RD
BLUE SPRINGS MO
64015-2963
US

V. Phone/Fax

Practice location:
  • Phone: 816-554-6520
  • Fax:
Mailing address:
  • Phone: 816-554-6520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: STEVEN B WEINRICH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 816-524-3223