MEDICARE: MATATU

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	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1578390001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATATU

Provider Business Mailing Address
First Line	:	6816 N MADISON AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-1038
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6816 N MADISON AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-1038
Country	:	US
Telephone Number	:	816-218-5562
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	RAMADHAN NKONGE
Credential	:
Telephone Number	:	816-218-5562

Provider Enumeration Date	:	09/18/2024
Last Update Date	:	09/18/2024

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Directions to “MATATU ” Practice Location

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