Healthcare Provider Details

I. General information

NPI: 1245785229
Provider Name (Legal Business Name): YOUNG MEN'S CHRISTIAN ASSOCIATION OF GREATER KANSAS CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2016
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 BROADWAY SUITE 1020
KANSAS CITY MO
64111-2413
US

IV. Provider business mailing address

3100 BROADWAY SUITE 1020
KANSAS CITY MO
64111-2413
US

V. Phone/Fax

Practice location:
  • Phone: 616-561-9622
  • Fax: 844-691-5926
Mailing address:
  • Phone: 616-561-9622
  • Fax: 844-691-5926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: JOHN MIKOS
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 816-561-9622