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General NPI Number Information
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NPI Number | 1952773533
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Entity Type | Organization
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Legal Business Name | KANSAS CITY CENTER FOR HIP PRESERVATION AND SPORTS MEDICINE
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Dates
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Enumeration Date | 10/22/2015
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Last Update Date | 12/09/2015
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Provider Practice Location Address
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Address Line | 6100 TIMBERIDGE
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City | PARKVILLE
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State | MO
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Zip | 64152-6099
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Country | US
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Telephone | 816-721-5140
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Fax |
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Provider Business Mailing Address
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Address Line | 5901 NW 63RD TER SUITE 120
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City | KANSAS CITY
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State | MO
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Zip | 64151-3319
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Country | US
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Telephone | 816-718-4010
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CODY STEPHEN HARLAN
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Credential | M.D.
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Telephone | 816-721-5140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 2010024964
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License Number State | MO
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