Healthcare Provider Details
I. General information
NPI: 1710615612
Provider Name (Legal Business Name): URGENT SPECIALTY ASSOCIATES OF MISSOURI LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/10/2022
Last Update Date: 08/10/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2330 E MEYER BLVD STE 209
KANSAS CITY MO
64132-1149
US
IV. Provider business mailing address
13500 POWERS CT STE 230
FORT MYERS FL
33912-4503
US
V. Phone/Fax
- Phone: 816-235-3932
- Fax: 816-709-1193
- Phone: 817-856-0065
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2086S0102X |
| Taxonomy | Surgical Critical Care Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
JOHN
D
JOSEPHS
Title or Position: PRESIDENT
Credential: MD
Phone: 469-609-9908