=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366817280
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH KANSAS CITY SLEEP THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2015
-----------------------------------------------------
Last Update Date | 02/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2008 SWIFT AVE
-----------------------------------------------------
City | NORTH KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64116-3424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-897-0746
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2008 SWIFT AVE
-----------------------------------------------------
City | NORTH KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64116-3424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WILLIAM BUSCH
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 816-668-5576
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 015161
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------