Healthcare Provider Details

I. General information

NPI: 1003268087
Provider Name (Legal Business Name): ADVANCED ORTHOPEDICS AND SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 10/20/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2861 NE INDEPENDENCE AVE STE 201
LEES SUMMIT MO
64064-2379
US

IV. Provider business mailing address

2861 NE INDEPENDENCE AVE STE 201
LEES SUMMIT MO
64064-2379
US

V. Phone/Fax

Practice location:
  • Phone: 816-525-2840
  • Fax: 816-525-2841
Mailing address:
  • Phone: 816-525-2840
  • Fax: 816-525-2841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW DAGGETT
Title or Position: VP OF OPERATIONS
Credential:
Phone: 816-525-2840