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NPI Code Detail

MEDICARE: STEPHENS ADVANCED WOUNDCARE LLC

MEDICARE: STEPHENS ADVANCED WOUNDCARE 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
1207PE0005XUndersea and Hyperbaric Medicine (Emergency Medicine) Physician102147MO
2207P00000XEmergency Medicine Physician102147MO

General Provider Information

NPI Number : 1699033233
Entity Type Code : Organization
Provider Name (Legal Business Name) : STEPHENS ADVANCED WOUNDCARE LLC
Provider Business Mailing Address
First Line : 10000 WORNALL RD
Second Line :
City : KANSAS CITY
State : MO
Zip : 64114-4359
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10000 WORNALL RD
Second Line :
City : KANSAS CITY
State : MO
Zip : 64114-4359
Country : US
Telephone Number : 816-942-0994
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : THAD A. STEPHENS
Credential : MD
Telephone Number : 913-526-8813
Provider Enumeration Date : 05/02/2012
Last Update Date : 05/02/2012

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Directions to “STEPHENS ADVANCED WOUNDCARE LLC ” Practice Location

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