Healthcare Provider Details

I. General information

NPI: 1730621988
Provider Name (Legal Business Name): NORTHLAND ORTHOPEDICS & SPORTS MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 CLAY EDWARDS DR STE 1230
NORTH KANSAS CITY MO
64116-3276
US

IV. Provider business mailing address

4000 W 6TH ST STE B #105
LAWRENCE KS
66049-3205
US

V. Phone/Fax

Practice location:
  • Phone: 816-214-9300
  • Fax: 816-214-9330
Mailing address:
  • Phone: 785-403-0405
  • Fax: 785-222-4504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateMO

VIII. Authorized Official

Name: STEVEN B SMITH
Title or Position: OWNER
Credential: M.D.
Phone: 816-841-3805