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General NPI Number Information
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NPI Number | 1225473473
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Entity Type | Organization
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Legal Business Name | JACKSON COUNTY PULMONARY MEDICAL GROUP LLC
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Dates
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Enumeration Date | 05/01/2013
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Last Update Date | 08/20/2013
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Provider Practice Location Address
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Address Line | 4911 S ARROWHEAD DR SUITE 201
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City | INDEPENDENCE
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State | MO
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Zip | 64055-7005
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Country | US
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Telephone | 816-478-8113
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Fax | 816-478-8108
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Provider Business Mailing Address
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Address Line | 4911 S ARROWHEAD DR SUITE 201
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City | INDEPENDENCE
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State | MO
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Zip | 64055-7005
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Country | US
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Telephone | 816-478-8113
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Fax | 816-478-8108
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Authorized Official
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Title or Position | VP
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Name | TODD CARLON
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Credential |
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Telephone | 816-508-4090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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