=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174015465
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRUMAN MEDICAL CENTER, INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2018
-----------------------------------------------------
Last Update Date | 09/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4545 S NOLAND RD
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64055-4887
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-404-9810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2301 HOLMES ST
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64108-2640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-404-3485
-----------------------------------------------------
Fax | 816-404-3601
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR, AUDIT & COMPLIANCE
-----------------------------------------------------
Name | BARBARA LYNN ZUBECK
-----------------------------------------------------
Credential | CPA
-----------------------------------------------------
Telephone | 816-404-3485
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 086773
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------