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General NPI Number Information
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NPI Number | 1013395235
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Entity Type | Organization
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Legal Business Name | BANNISTER INTERNAL MEDICINE CLINIC
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Dates
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Enumeration Date | 05/07/2015
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Last Update Date | 07/20/2015
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Provider Practice Location Address
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Address Line | 9520 JAMES A REED RD SUITE B
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City | KANSAS CITY
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State | MO
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Zip | 64134-1689
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Country | US
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Telephone | 816-599-6317
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Fax | 816-599-6319
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Provider Business Mailing Address
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Address Line | 9520 JAMES A REED RD SUITE B
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City | KANSAS CITY
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State | MO
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Zip | 64134-1689
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Country | US
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Telephone | 816-599-6317
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Fax | 816-599-6319
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Authorized Official
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Title or Position | OWNER
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Name | DR. FATIMA H KHAN
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Credential | D.O
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Telephone | 816-599-6317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 2010019768
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License Number State | MO
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