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General NPI Number Information
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NPI Number | 1760801534
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Entity Type | Organization
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Legal Business Name | PRIMECARE CONSULTING
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Dates
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Enumeration Date | 04/09/2014
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Last Update Date | 04/09/2014
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Provider Practice Location Address
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Address Line | 9233 WARD PKWY 362
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City | KANSAS CITY
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State | MO
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Zip | 64114-3366
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Country | US
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Telephone | 816-460-4155
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Fax |
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Provider Business Mailing Address
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Address Line | 9233 WARD PKWY 362
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City | KANSAS CITY
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State | MO
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Zip | 64114-3366
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | EDEN WHEELER
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Credential | M.D.
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Telephone | 816-560-4155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 105924
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License Number State | MO
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