Healthcare Provider Details

I. General information

NPI: 1073570487
Provider Name (Legal Business Name): CLAY PLATTE FAMILY MEDICINE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 NW 62ND TER STE 100
KANSAS CITY MO
64151-2412
US

IV. Provider business mailing address

5501 NW 62ND TER STE 100
KANSAS CITY MO
64151-2412
US

V. Phone/Fax

Practice location:
  • Phone: 816-842-4440
  • Fax: 816-842-1974
Mailing address:
  • Phone: 816-842-4440
  • Fax: 816-842-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT H KUENNEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 816-842-4440