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NPI Code Detail

MEDICARE: AMBER WATT

MEDICARE: AMBER WATT
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
1291U00000XClinical Medical Laboratory2004025921MO

General Provider Information

NPI Number : 1184780199
Entity Type Code : Organization
Provider Name (Legal Business Name) : AMBER WATT
Provider Business Mailing Address
First Line : 4050 BROADWAY ST
Second Line : SUITE 220
City : KANSAS CITY
State : MO
Zip : 64111-2615
Country : US
Telephone Number : 816-960-3510
Fax Number : 866-258-2170
Provider Business Practice Location Address
First Line : 4050 BROADWAY ST
Second Line : SUITE 220
City : KANSAS CITY
State : MO
Zip : 64111-2615
Country : US
Telephone Number : 816-960-3510
Fax Number : 866-258-2170
Authorized Official
Title or Position : CEO
Name : AMBER WATT
Credential :
Telephone Number : 816-960-3510
Provider Enumeration Date : 12/28/2006
Last Update Date : 09/19/2008

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