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General NPI Number Information
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NPI Number | 1194116061
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Entity Type | Organization
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Legal Business Name | SIGNATURE MEDICAL GROUP OF KC, PA
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 2737 NE MCBAINE DR STE A
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City | LEES SUMMIT
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State | MO
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Zip | 64064-7880
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Country | US
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Telephone | 913-381-5225
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Fax | 913-901-0186
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Provider Business Mailing Address
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Address Line | 12639 OLD TESSON RD STE 115
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2786
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Country | US
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Telephone | 314-849-0311
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Fax | 314-849-4423
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Authorized Official
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Title or Position | CEO
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Name | CHAD SACKMAN
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Credential |
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Telephone | 314-849-0311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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