Healthcare Provider Details

I. General information

NPI: 1427220375
Provider Name (Legal Business Name): CARONDELET PHYSICIAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 NW MOCK AVE SUITE 200
BLUE SPRINGS MO
64014-2543
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: 816-220-3100
  • Fax: 816-220-4738
Mailing address:
  • Phone: 816-655-5792
  • Fax: 816-655-5787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberR6P77
License Number StateMO

VIII. Authorized Official

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