MEDICARE: DR. JAY W KIMBALL MD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	R6A86	MO

General Provider Information

NPI Number	:	1114904398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY W KIMBALL MD.

Provider Business Mailing Address
First Line	:	9411 N OAK TRFY
Second Line	:	# LL1
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-2233
Country	:	US
Telephone Number	:	816-436-7072
Fax Number	:	816-436-2743

Provider Business Practice Location Address
First Line	:	6450 N CHATHAM AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64151
Country	:	US
Telephone Number	:	816-741-5542
Fax Number	:	816-746-4262

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	12/19/2013

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