Healthcare Provider Details

I. General information

NPI: 1295792224
Provider Name (Legal Business Name): KANSAS CITY PULMONARY CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 PROSPECT AVENUE T303 KANSAS CITY PULMONARY CLINIC PA
KANSAS CITY MO
64132
US

IV. Provider business mailing address

6420 PROSPECT AVENUE T303 KANSAS CITY PULMONARY CLINIC PA
KANSAS CITY MO
64132
US

V. Phone/Fax

Practice location:
  • Phone: 816-333-1919
  • Fax: 816-361-1930
Mailing address:
  • Phone: 816-333-1919
  • Fax: 816-361-1930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. LINDA WAGNER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 816-333-1919