MEDICARE: FREE FROM MARKETPLACE, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	133N00000X	Nutritionist
2	133V00000X	Registered Dietitian
3	171400000X	Health & Wellness Coach
4	332U00000X	Home Delivered Meals
5	335G00000X	Medical Foods Supplier

General Provider Information

NPI Number	:	1174217731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREE FROM MARKETPLACE, INC.

Provider Business Mailing Address
First Line	:	420 NICHOLS RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64112-2005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 NICHOLS RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64112-2005
Country	:	US
Telephone Number	:	913-202-4692
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	EMILY BROWN
Credential	:
Telephone Number	:	816-280-4134

Provider Enumeration Date	:	06/06/2023
Last Update Date	:	06/06/2023

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