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General NPI Number Information
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NPI Number | 1891901054
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Entity Type | Organization
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Legal Business Name | COMMUNITY HOUSE OF WELLNESS
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 09/29/2010
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Provider Practice Location Address
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Address Line | 1121 QUINDARO BLVD
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City | KANSAS CITY
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State | KS
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Zip | 66104-5331
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Country | US
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Telephone | 913-233-1733
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Fax | 913-233-0055
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Provider Business Mailing Address
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Address Line | 1121 QUINDARO BLVD
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City | KANSAS CITY
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State | KS
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Zip | 66104-5331
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Country | US
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Telephone | 913-233-1733
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Fax | 913-233-0055
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MARVIN MCINTOSH
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Credential | MEDICAL DOCTOR
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Telephone | 913-233-1733
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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 | 0428352
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License Number State | KS
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