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NPI Code Detail

MEDICARE: KC GERIATRICS LLC

MEDICARE: KC GERIATRICS 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
1207RG0300XGeriatric Medicine (Internal Medicine) Physician

General Provider Information

NPI Number : 1457956690
Entity Type Code : Organization
Provider Name (Legal Business Name) : KC GERIATRICS LLC
Provider Business Mailing Address
First Line : 3014 OAK ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64108-3240
Country : US
Telephone Number : 816-982-9750
Fax Number : 816-931-9833
Provider Business Practice Location Address
First Line : 3014 OAK ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64108-3240
Country : US
Telephone Number : 816-982-9750
Fax Number : 816-931-9833
Authorized Official
Title or Position : MANAGER
Name : LORI ROBERTS
Credential :
Telephone Number : 816-982-9750
Provider Enumeration Date : 12/04/2020
Last Update Date : 12/04/2020

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Directions to “KC GERIATRICS LLC ” Practice Location

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