Healthcare Provider Details

I. General information

NPI: 1619404829
Provider Name (Legal Business Name): DONNER SUMMIT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 08/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9151 NE 81ST TER STE 240
KANSAS CITY MO
64158-1307
US

IV. Provider business mailing address

9151 NE 81ST TER SUITE 240
KANSAS CITY MO
64158
US

V. Phone/Fax

Practice location:
  • Phone: 816-977-3291
  • Fax:
Mailing address:
  • Phone: 816-977-3291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2010037363
License Number StateMO

VIII. Authorized Official

Name: DR. JOHN BILLHARZ
Title or Position: OWNER
Credential: MD
Phone: 816-977-3291