Healthcare Provider Details

I. General information

NPI: 1770535197
Provider Name (Legal Business Name): UROLOGY SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 CLAY EDWARDS DR STE 300
NKC MO
64116-3249
US

IV. Provider business mailing address

2700 CLAY EDWARDS DR STE 300
NKC MO
64116-3249
US

V. Phone/Fax

Practice location:
  • Phone: 816-842-0171
  • Fax: 816-842-3582
Mailing address:
  • Phone: 816-842-0171
  • Fax: 816-842-3582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMDR4926
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR2E53
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number105398
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number31894
License Number StateMO

VIII. Authorized Official

Name: MRS. KERRY LYNN ARNOLD
Title or Position: BILLING/INSURANCE
Credential:
Phone: 816-221-6845