MEDICARE: MISSION HEALTH SERVICES

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	314000000X	Skilled Nursing Facility	2005 NCF 467	UT

General Provider Information

NPI Number	:	1457338956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSION HEALTH SERVICES

Provider Business Mailing Address
First Line	:	5007 S MISSION DR
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64505-9404
Country	:	US
Telephone Number	:	816-232-9573
Fax Number	:	816-232-9596

Provider Business Practice Location Address
First Line	:	1216 E 1300 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-1949
Country	:	US
Telephone Number	:	801-487-5865
Fax Number	:	801-487-5869

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GARY M. KELSO
Credential	:
Telephone Number	:	801-389-1523

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	09/16/2014

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Directions to “MISSION HEALTH SERVICES ” Practice Location

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