Healthcare Provider Details

I. General information

NPI: 1902832611
Provider Name (Legal Business Name): NORTHLAND BONE & JOINT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 09/15/2008
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

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

V. Phone/Fax

Practice location:
  • Phone: 816-214-9345
  • Fax: 816-214-9330
Mailing address:
  • Phone: 816-214-9345
  • Fax: 816-214-9330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LESLIE D THOMAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 816-214-9300