Healthcare Provider Details

I. General information

NPI: 1124677299
Provider Name (Legal Business Name): COOPERATING PLAN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 NW JEFFERSON ST
BLUE SPRINGS MO
64015-7242
US

IV. Provider business mailing address

1501 NW JEFFERSON ST
BLUE SPRINGS MO
64015-7242
US

V. Phone/Fax

Practice location:
  • Phone: 816-224-1740
  • Fax: 816-224-1364
Mailing address:
  • Phone: 816-224-1740
  • Fax: 816-224-1364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY ABRAM
Title or Position: PRESIDENT
Credential:
Phone: 816-365-1866