Healthcare Provider Details

I. General information

NPI: 1194116061
Provider Name (Legal Business Name): SIGNATURE MEDICAL GROUP OF KC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2737 NE MCBAINE DR STE A
LEES SUMMIT MO
64064-7880
US

IV. Provider business mailing address

12639 OLD TESSON RD STE 115
SAINT LOUIS MO
63128-2786
US

V. Phone/Fax

Practice location:
  • Phone: 913-381-5225
  • Fax: 913-901-0186
Mailing address:
  • Phone: 314-849-0311
  • Fax: 314-849-4423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CHAD SACKMAN
Title or Position: CEO
Credential:
Phone: 314-849-0311