Healthcare Provider Details

I. General information

NPI: 1629702741
Provider Name (Legal Business Name): KC SPECIALTIES OCCUPATIONAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4741 S ARROWHEAD DR
INDEPENDENCE MO
64055-6957
US

IV. Provider business mailing address

4741 S ARROWHEAD DR
INDEPENDENCE MO
64055-6957
US

V. Phone/Fax

Practice location:
  • Phone: 816-795-6000
  • Fax:
Mailing address:
  • Phone: 816-795-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JONATHAN MELENDEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 816-795-6000