Healthcare Provider Details

I. General information

NPI: 1063693232
Provider Name (Legal Business Name): CARONDELET PHYSICIAN SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 NW RD MIZE RD SUITE 101
BLUE SPRINGS MO
64014-2527
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: 816-228-9841
  • Fax: 816-228-1514
Mailing address:
  • Phone: 816-655-5792
  • Fax: 816-655-5787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0431315
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2006003132
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberR8H50
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2004006974
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number100628
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2010008119
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR4B19
License Number StateMO
# 8
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35929
License Number StateMO

VIII. Authorized Official

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