Healthcare Provider Details

I. General information

NPI: 1467729988
Provider Name (Legal Business Name): SIGNATURE MEDICAL GROUP OF KC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2011
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

10701 NALL AVE SUITE 200
OVERLAND PARK KS
66211-1363
US

V. Phone/Fax

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

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: MR. MIKE STEPHENSON
Title or Position: ADMINISTATOR
Credential:
Phone: 913-381-5225