Healthcare Provider Details

I. General information

NPI: 1669629960
Provider Name (Legal Business Name): JOAN P MOORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 CARONDELET DRIVE #421
KANSAS CITY MO
64114
US

IV. Provider business mailing address

1010 CARONDELET DR SUITE #421
KANSAS CITY MO
64114-4859
US

V. Phone/Fax

Practice location:
  • Phone: 816-941-9700
  • Fax: 816-941-9700
Mailing address:
  • Phone: 816-941-9700
  • Fax: 816-941-4302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberR4024
License Number StateMO

VIII. Authorized Official

Name: DR. JOAN P MOORE
Title or Position: DOCTOR
Credential: MD
Phone: 816-941-9700