MEDICARE: SAMUEL U. RODGERS HEALTH CENTER, 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	261QF0400X	Federally Qualified Health Center (FQHC)		MO

General Provider Information

NPI Number	:	1386195113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMUEL U. RODGERS HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	825 EUCLID AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64124-2323
Country	:	US
Telephone Number	:	816-474-4920
Fax Number	:	816-889-1845

Provider Business Practice Location Address
First Line	:	5330 N OAK TRFY STE 104
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-4600
Country	:	US
Telephone Number	:	816-889-1950
Fax Number	:	816-499-8101

Authorized Official
Title or Position	:	PRESIDENT & CHIEF EXECUTIVE OFFICER
Name	:	HILDA FUENTES
Credential	:	MPA
Telephone Number	:	816-889-4600

Provider Enumeration Date	:	10/17/2016
Last Update Date	:	07/21/2022

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