MEDICARE: SOUTHERNCARE, INC.

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	251G00000X	Community Based Hospice Care Agency	1211H0	MO
2	251G00000X	Community Based Hospice Care Agency	121-11HO	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205877073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERNCARE, INC.

Provider Business Mailing Address
First Line	:	655 BRAWLEY SCHOOL RD
Second Line	:	SUITE 200
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-9125
Country	:	US
Telephone Number	:	704-664-2876
Fax Number	:	704-664-1306

Provider Business Practice Location Address
First Line	:	1240 NE WINDSOR DR
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64086-5594
Country	:	US
Telephone Number	:	816-524-3663
Fax Number	:	816-524-3669

Authorized Official
Title or Position	:	VP OF LEGAL AFFAIRS
Name	:	JESSICA KLEBERG
Credential	:
Telephone Number	:	704-664-2876

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	05/16/2016

Similar Medicare Providers

1538019948 — HALEY MOORE MFT
Practice Location Address:

1272 NE WINDSOR DR
LEES SUMMIT, MO
64086-5594

Practice Phone: 816-246-4465
Practice Fax: 816-524-7008

1285613240 — MR. MATTHEW R HLAVACEK MD, DDS
Practice Location Address:

1208 NE WINDSOR DR
LEES SUMMIT, MO
64086-5594

Practice Phone: 816-524-4334
Practice Fax: 816-524-4399

1891760880 — DR. MICKEY LEE UNSELL DDS
Practice Location Address:

1218 NE WINDSOR DR
LEES SUMMIT, MO
64086-5594

Practice Phone: 816-554-7668
Practice Fax: 816-554-7651

1588626659 — DR. STEVEN J PRSTOJEVICH MD DDS
Practice Location Address:

1208 NE WINDSOR DR
LEES SUMMIT, MO
64086-5594

Practice Phone: 816-524-4334
Practice Fax: 816-524-4399

1316994841 — REPRODUCTIVE ENDOCRINE-INFERTILITY CARE, P.A.
Practice Location Address:

1206 NE WINDSOR DR
LEES SUMMIT, MO
64086-5594

Practice Phone: 816-246-7665
Practice Fax: 816-554-6677

1841238482 — DR. NEZAAM M. ZAMAH M.D.
Practice Location Address:

1206 NE WINDSOR DR
LEES SUMMIT, MO
64086-5594

Practice Phone: 816-246-7665
Practice Fax: 816-554-6677

Directions to “SOUTHERNCARE, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.