MEDICARE: KS URGENT CARE CENTER OF KANSAS CITY LLC

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	261QU0200X	Urgent Care Clinic/Center	04-13380	KS

General Provider Information

NPI Number	:	1174562052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KS URGENT CARE CENTER OF KANSAS CITY LLC

Provider Business Mailing Address
First Line	:	1601 MEADOWLARK LN
Second Line	:	SUITE D
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-1266
Country	:	US
Telephone Number	:	913-287-1400
Fax Number	:	913-287-1402

Provider Business Practice Location Address
First Line	:	1601 MEADOWLARK LN
Second Line	:	SUITE D
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-1266
Country	:	US
Telephone Number	:	913-287-1400
Fax Number	:	913-287-1402

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. ALAN C HANCOCK
Credential	:	M.D.
Telephone Number	:	913-287-1400

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	10/08/2008

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