Healthcare Provider Details

I. General information

NPI: 1376905216
Provider Name (Legal Business Name): KANSAS CITY CARE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2016
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 BROADWAY BLVD
KANSAS CITY MO
64111-2537
US

IV. Provider business mailing address

3515 BROADWAY BLVD
KANSAS CITY MO
64111-2537
US

V. Phone/Fax

Practice location:
  • Phone: 816-777-2709
  • Fax: 816-777-1544
Mailing address:
  • Phone: 816-777-2709
  • Fax: 816-777-1544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2016006896
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS WILSON FRANKLIN
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 816-777-2763