=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427093988
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CROSSROADS HOSPICE OF KANSAS CITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2006
-----------------------------------------------------
Last Update Date | 11/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14310 E 42ND ST S STE 600
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64055-7308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-333-9200
-----------------------------------------------------
Fax | 816-333-9444
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10810 E 45TH ST SUITE 300
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74146-3818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-627-6846
-----------------------------------------------------
Fax | 918-627-6856
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO/COO
-----------------------------------------------------
Name | MR. CLAYTON LEE FARMER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 918-627-6846
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QH0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | 056-8HO
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------