MEDICARE: CARONDELET PHYSICIAN SERVICES 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	207X00000X	Orthopaedic Surgery Physician	R6P77	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39532013	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1427220375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARONDELET PHYSICIAN SERVICES INC

Provider Business Mailing Address
First Line	:	801 NW SAINT MARY DR
Second Line	:	SUITE 230
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-2524
Country	:	US
Telephone Number	:	816-655-5792
Fax Number	:	816-655-5787

Provider Business Practice Location Address
First Line	:	300 NW MOCK AVE
Second Line	:	SUITE 200
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-2543
Country	:	US
Telephone Number	:	816-220-3100
Fax Number	:	816-220-4738

Authorized Official
Title or Position	:	CFO
Name	:	MR. STEVEN R CLEARY
Credential	:
Telephone Number	:	816-943-2819

Provider Enumeration Date	:	04/01/2008
Last Update Date	:	07/29/2010

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Directions to “CARONDELET PHYSICIAN SERVICES INC ” Practice Location

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