Healthcare Provider Details

I. General information

NPI: 1174300263
Provider Name (Legal Business Name): CMC COMPREHENSIVE CARE BLUE SPRINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 W MAIN ST STE F
BLUE SPRINGS MO
64015-3611
US

IV. Provider business mailing address

1131 W MAIN ST STE F
BLUE SPRINGS MO
64015-3611
US

V. Phone/Fax

Practice location:
  • Phone: 816-229-1941
  • Fax: 816-229-7085
Mailing address:
  • Phone: 816-229-1941
  • Fax: 816-229-7085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. ASTON GOLDSWORTHY
Title or Position: OWNER
Credential: DC, FNP-BC
Phone: 816-674-2693