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General NPI Number Information
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NPI Number | 1598572059
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Entity Type | Organization
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Legal Business Name | GEN 3 IV HYDRATION AND WELLNESS
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Dates
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Enumeration Date | 12/17/2024
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 418 NW LEGACY DR
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City | KANSAS CITY
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State | MO
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Zip | 64155-2894
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Country | US
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Telephone | 816-599-0053
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Fax |
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Provider Business Mailing Address
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Address Line | 1210 NE CORONADO DR
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City | BLUE SPRINGS
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State | MO
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Zip | 64014-2928
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Country | US
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Telephone | 816-661-0335
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Fax | 816-552-1228
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER MAXEY
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Credential | RN
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Telephone | 816-560-2286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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