MEDICARE: HEALTH CENTERS OF AMERICA-KANSAS CITY, 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	208000000X	Pediatrics Physician	04-13367	KS
2	174400000X	Specialist	R3788	MO

General Provider Information

NPI Number	:	1649467937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH CENTERS OF AMERICA-KANSAS CITY, LLC

Provider Business Mailing Address
First Line	:	5308 E 115TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64137-2731
Country	:	US
Telephone Number	:	816-763-9165
Fax Number	:	816-763-9208

Provider Business Practice Location Address
First Line	:	5308 E 115TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64137-2731
Country	:	US
Telephone Number	:	816-763-9165
Fax Number	:	816-763-9208

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. CAROL RYSER
Credential	:
Telephone Number	:	816-763-9165

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	02/26/2010

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