Healthcare Provider Details

I. General information

NPI: 1225439904
Provider Name (Legal Business Name): WESTPORT PLAZA MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4218 ROANOKE RD SUITE 210
KANSAS CITY MO
64111-3198
US

IV. Provider business mailing address

4218 ROANOKE RD SUITE 210
KANSAS CITY MO
64111-3198
US

V. Phone/Fax

Practice location:
  • Phone: 816-841-4865
  • Fax: 816-841-4801
Mailing address:
  • Phone: 816-841-4865
  • Fax: 816-841-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MISS ERIN LOUISA BISHOP
Title or Position: PRESIDENT
Credential:
Phone: 816-841-4865