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General NPI Number Information
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NPI Number | 1154877157
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Entity Type | Organization
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Legal Business Name | GLADSTONE FAMILY CARE, LLC
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Dates
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Enumeration Date | 08/30/2016
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Last Update Date | 10/04/2016
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Provider Practice Location Address
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Address Line | 6717 N OAK TRFY
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City | GLADSTONE
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State | MO
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Zip | 64118-3346
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Country | US
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Telephone | 816-678-7223
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Fax |
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Provider Business Mailing Address
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Address Line | 6717 N OAK TRFY
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City | GLADSTONE
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State | MO
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Zip | 64118-3346
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Country | US
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Telephone | 816-678-7223
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MISS TIFFANY A COVEY
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Credential |
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Telephone | 816-678-7223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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