Healthcare Provider Details

I. General information

NPI: 1649612219
Provider Name (Legal Business Name): METRO TREATMENT OF MISSOURI, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3935 SHERMAN AVE
SAINT JOSEPH MO
64506-3649
US

IV. Provider business mailing address

2500 MAITLAND CENTER PARKWAY SUITE 250
MAITLAND FL
32751-4174
US

V. Phone/Fax

Practice location:
  • Phone: 816-233-7300
  • Fax: 816-233-7306
Mailing address:
  • Phone: 407-351-7080
  • Fax: 407-351-6930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number1338
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1692002272
License Number StateMO

VIII. Authorized Official

Name: MR. RODNEY WILLIAMS
Title or Position: VICE PRESIDENT
Credential:
Phone: 407-581-5157