MEDICARE: MR. BEN SCOTT LONGSTROTH RN

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	163W00000X	Registered Nurse	2011003614	MO

General Provider Information

NPI Number	:	1366735110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BEN SCOTT LONGSTROTH RN

Provider Business Mailing Address
First Line	:	5303 E TRUMAN RD
Second Line	:	#201
City	:	KANSAS CITY
State	:	MO
Zip	:	64127-2888
Country	:	US
Telephone Number	:	816-457-2572
Fax Number	:

Provider Business Practice Location Address
First Line	:	5303 E TRUMAN RD
Second Line	:	#201
City	:	KANSAS CITY
State	:	MO
Zip	:	64127-2888
Country	:	US
Telephone Number	:	816-457-2572
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2011
Last Update Date	:	05/25/2011

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