Healthcare Provider Details

I. General information

NPI: 1497416986
Provider Name (Legal Business Name): HAINES I.T., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9216 N DAWN AVE
KANSAS CITY MO
64154-1401
US

IV. Provider business mailing address

9216 N DAWN AVE
KANSAS CITY MO
64154-1401
US

V. Phone/Fax

Practice location:
  • Phone: 816-323-0201
  • Fax:
Mailing address:
  • Phone: 816-323-0201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: JACK HAINES
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 816-323-0201