MEDICARE: INDEPENDENCE OPERATIONS 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	310400000X	Assisted Living Facility	035304	MO
2	314000000X	Skilled Nursing Facility	035303	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760679625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENCE OPERATIONS LLC

Provider Business Mailing Address
First Line	:	1500 WATERS RIDGE DR
Second Line	:	STE 200
City	:	LEWISVILLE
State	:	TX
Zip	:	75057-6011
Country	:	US
Telephone Number	:	972-899-4401
Fax Number	:	972-899-4806

Provider Business Practice Location Address
First Line	:	3980 S. JACKSON DR.
Second Line	:
City	:	INDEPENDENCE
State	:	MO
Zip	:	64057-1706
Country	:	US
Telephone Number	:	816-795-1433
Fax Number	:	816-795-1766

Authorized Official
Title or Position	:	AUTHORIZED OFFICER
Name	:	PAULA PIERCE
Credential	:
Telephone Number	:	972-899-4401

Provider Enumeration Date	:	09/25/2007
Last Update Date	:	06/02/2008

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Directions to “INDEPENDENCE OPERATIONS LLC ” Practice Location

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