Healthcare Provider Details

I. General information

NPI: 1013526847
Provider Name (Legal Business Name): AFYA CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 11/27/2020
Certification Date: 11/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 E 12TH ST
KANSAS CITY MO
64127-1246
US

IV. Provider business mailing address

2319 E 12TH ST
KANSAS CITY MO
64127-1246
US

V. Phone/Fax

Practice location:
  • Phone: 816-824-7219
  • Fax:
Mailing address:
  • Phone: 816-824-7219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. FARHIYA ALEW
Title or Position: DIRECTOR
Credential: APRN
Phone: 816-824-7219