Healthcare Provider Details

I. General information

NPI: 1053341750
Provider Name (Legal Business Name): LEES SUMMIT PHYSICIANS GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 NW BLUE PKWY
LEES SUMMIT MO
64086-5705
US

IV. Provider business mailing address

1425 NW BLUE PKWY
LEES SUMMIT MO
64086-5705
US

V. Phone/Fax

Practice location:
  • Phone: 816-524-3223
  • Fax: 816-525-2697
Mailing address:
  • Phone: 816-524-3223
  • Fax: 816-525-2697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. STEVEN B. WEINRICH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 816-524-3223