Healthcare Provider Details

I. General information

NPI: 1588380919
Provider Name (Legal Business Name): JACK OF TRADES SALES CONTRACTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 BELLEFONTAINE AVE
KANSAS CITY MO
64130-3954
US

IV. Provider business mailing address

6201 BELLEFONTAINE AVE
KANSAS CITY MO
64130-3954
US

V. Phone/Fax

Practice location:
  • Phone: 913-667-0600
  • Fax: 816-800-9219
Mailing address:
  • Phone: 913-667-0600
  • Fax: 816-800-9219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XR0403X
TaxonomyDriving and Community Mobility Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: DAMIEN PAYTON
Title or Position: PRESIDENT
Credential:
Phone: 913-667-0600