MEDICARE: NEW BALLOON 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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1366707291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW BALLOON LLC

Provider Business Mailing Address
First Line	:	PO BOX 8882
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-8882
Country	:	US
Telephone Number	:	816-533-4757
Fax Number	:	816-817-0657

Provider Business Practice Location Address
First Line	:	811 E 72ND ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-1605
Country	:	US
Telephone Number	:	816-533-4757
Fax Number	:	816-817-0657

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KEENAN C STUMP
Credential	:
Telephone Number	:	816-533-4757

Provider Enumeration Date	:	07/06/2012
Last Update Date	:	07/06/2012

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Directions to “NEW BALLOON LLC ” Practice Location

Language	Start Address	Practice Location

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