Healthcare Provider Details

I. General information

NPI: 1376974386
Provider Name (Legal Business Name): JEANNE MALIWAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANNE COMBS RT, R, CT, M, BD

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 E LINWOOD BLVD
KANSAS CITY MO
64128-2226
US

IV. Provider business mailing address

5005 PARK RIDGE DR
BLUE SPRINGS MO
64015-8319
US

V. Phone/Fax

Practice location:
  • Phone: 816-861-4700
  • Fax:
Mailing address:
  • Phone: 816-678-1449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number279385
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2471B0102X
TaxonomyBone Densitometry Radiologic Technologist
License Number279385
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number279385
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number279385
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code2471M2300X
TaxonomyMammography Radiologic Technologist
License Number279385
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: