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General NPI Number Information
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NPI Number | 1316137953
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Entity Type | Organization
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Legal Business Name | MIDWEST HEMORRHOID TREATMENT CENTER NORTH KANSAS CITY LLC
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 11/08/2007
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Provider Practice Location Address
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Address Line | 2700 CLAY EDWARDS DR SUITE 260
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City | NORTH KANSAS CITY
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State | MO
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Zip | 64116-3237
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Country | US
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Telephone | 816-421-0601
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Fax | 816-421-0604
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Provider Business Mailing Address
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Address Line | PO BOX 7127
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City | SHAWNEE MISSION
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State | KS
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Zip | 66207-0127
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Country | US
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Telephone | 816-421-0601
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Fax | 816-421-0604
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ROBERT ANTHONY MOULTON
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Credential | D.O.
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Telephone | 913-451-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | LC0811343
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License Number State | MO
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