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General NPI Number Information
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NPI Number | 1699040006
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Entity Type | Organization
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Legal Business Name | CARONDELET PHYSICIAN SERVICES, INC.
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Dates
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Enumeration Date | 03/19/2012
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Last Update Date | 03/19/2012
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Provider Practice Location Address
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Address Line | 1454 SW EAGLES PKWY
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City | GRAIN VALLEY
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State | MO
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Zip | 64029-8508
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Country | US
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Telephone | 816-847-2390
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Fax | 816-847-2392
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Provider Business Mailing Address
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Address Line | 801 NW SAINT MARY DR SUITE 230
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City | BLUE SPRINGS
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State | MO
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Zip | 64014-2524
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Country | US
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Telephone | 816-655-5792
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Fax | 816-655-5787
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Authorized Official
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Title or Position | VP AND CFO
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Name | MR. STEVEN R CLEARY
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Credential |
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Telephone | 816-943-2819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 106682
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License Number State | MO
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