Healthcare Provider Details

I. General information

NPI: 1760659734
Provider Name (Legal Business Name): MIDWEST CERTIFIED FIRST ASSISTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7619 E 76TH ST
KANSAS CITY MO
64138-1121
US

IV. Provider business mailing address

7619 E 76TH ST
KANSAS CITY MO
64138-1121
US

V. Phone/Fax

Practice location:
  • Phone: 816-358-4316
  • Fax:
Mailing address:
  • Phone: 816-358-4316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number06-302
License Number StateMO

VIII. Authorized Official

Name: MR. ROBERT ANTHONY EVERETTE
Title or Position: CERTIFIED FIRST ASSISTANT
Credential: SA-C
Phone: 816-358-4316