MEDICARE: MR. ROBERT ANTHONY EVERETTE SA-C

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	246ZS0410X	Surgical Technologist	246ZS0400X	MO

General Provider Information

NPI Number	:	1760692875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT ANTHONY EVERETTE SA-C

Provider Business Mailing Address
First Line	:	PO BOX 300674
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64130-0674
Country	:	US
Telephone Number	:	816-358-4316
Fax Number	:

Provider Business Practice Location Address
First Line	:	7619 E 76TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64138-1121
Country	:	US
Telephone Number	:	816-358-4316
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	09/08/2011

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Directions to “ MR. ROBERT ANTHONY EVERETTE SA-C” Practice Location

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