MEDICARE: SPELL FITCH WOMEN'S CARE, 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	207V00000X	Obstetrics & Gynecology Physician	2003003400	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	:	1437583044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPELL FITCH WOMEN'S CARE, LLC

Provider Business Mailing Address
First Line	:	614 NW ENGLEWOOD RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-3973
Country	:	US
Telephone Number	:	816-621-7700
Fax Number	:	816-621-7707

Provider Business Practice Location Address
First Line	:	614 NW ENGLEWOOD RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-3973
Country	:	US
Telephone Number	:	816-621-7700
Fax Number	:	816-621-7707

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MRS. VIRGINIA D FREEMAN
Credential	:
Telephone Number	:	816-621-7700

Provider Enumeration Date	:	08/30/2013
Last Update Date	:	08/30/2013

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