Healthcare Provider Details

I. General information

NPI: 1043315641
Provider Name (Legal Business Name): RESTORED IMAGES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4116 NE VIVION RD
KANSAS CITY MO
64119-2811
US

IV. Provider business mailing address

4116 NE VIVION RD
KANSAS CITY MO
64119-2811
US

V. Phone/Fax

Practice location:
  • Phone: 816-454-2900
  • Fax: 816-454-5881
Mailing address:
  • Phone: 816-454-2900
  • Fax: 816-454-5881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number14757222
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number14757222
License Number StateMO

VIII. Authorized Official

Name: MRS. REBECCA WILLS
Title or Position: PRESIDENT
Credential:
Phone: 816-454-2900