Healthcare Provider Details

I. General information

NPI: 1649467937
Provider Name (Legal Business Name): HEALTH CENTERS OF AMERICA-KANSAS CITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5308 E 115TH ST
KANSAS CITY MO
64137-2731
US

IV. Provider business mailing address

5308 E 115TH ST
KANSAS CITY MO
64137-2731
US

V. Phone/Fax

Practice location:
  • Phone: 816-763-9165
  • Fax: 816-763-9208
Mailing address:
  • Phone: 816-763-9165
  • Fax: 816-763-9208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR3788
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-13367
License Number StateKS

VIII. Authorized Official

Name: DR. CAROL RYSER
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 816-763-9165